{"hospital_name": "SMSJ Tucson Holdings LLC", "last_updated_on": "2026-04-16", "version": "3.0.0", "pid": "1846046860", "rid": "12999", "location_name": ["Carondelet Marana Micro Hospital"], "hospital_address": ["5620 W Cortaro Farms Rd, Tucson, AZ 85742"], "type_2_npi": ["1265818488"], "license_information": {"license_number": "SH10006", "state": "AZ"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "1 ADMN RSV MONOC ANTB IM NJX", "code_information": [{"code": "96381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4206", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.13, "maximum": 144.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 144.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "11-DEOXYXORTISL", "code_information": [{"code": "82634", "type": "CPT"}, {"code": "7252517", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.06, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 30.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 629.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 629.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 474.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 474.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 300.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 300.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 663.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 221.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 485.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 485.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 292.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3848.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 641.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 341.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4207", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 288.27, "maximum": 288.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 383.09, "maximum": 383.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 288.27, "maximum": 288.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 383.09, "maximum": 383.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 216.2, "maximum": 216.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 216.2, "maximum": 216.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.99, "maximum": 219.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 219.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.99, "maximum": 219.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 219.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "20+ CC SYRINGE ONLY", "code_information": [{"code": "A4213", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.47, "maximum": 136.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.07, "maximum": 110.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 572.78, "maximum": 572.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3 CC STERILE SYRINGE&NEEDLE", "code_information": [{"code": "A4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2356.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2356.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 442.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1664.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1849.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 933.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}, {"code": "4603324", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 201.98, "gross_charge": 1691.0, "discounted_cash": 1268.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D IMAGING W POSTPROCESS", "code_information": [{"code": "76377", "type": 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "4919083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6731.0, "discounted_cash": 5048.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "5059083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9664.0, "discounted_cash": 7248.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGE", "code_information": [{"code": "5069083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6731.0, "discounted_cash": 5048.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W/IMAGING", "code_information": [{"code": "49083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6351.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 194.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 1 VIEW", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "4904018", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 250.1, "gross_charge": 1480.0, "discounted_cash": 1110.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 225.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 250.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN 2 VIEWS", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "4904019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 460.81, "gross_charge": 1884.0, "discounted_cash": 1413.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 460.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABDOMEN/CHEST DET FORBDY", "code_information": [{"code": "76010", "type": "CPT"}, {"code": "4904030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.01, "gross_charge": 1443.0, "discounted_cash": 1082.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABG W CALC O2 SAT", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "5501806", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.88, "gross_charge": 2021.0, "discounted_cash": 1515.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABG W O2 DIRECT", "code_information": [{"code": "82805", "type": "CPT"}, {"code": "5500152", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 298.77, "gross_charge": 1540.0, "discounted_cash": 1155.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 55.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 62.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 29.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 32.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 298.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1137.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 334.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 371.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1137.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4856.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1621.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ADD-ON", "code_information": [{"code": "33257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2084.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4853.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1625.07, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS ADD-ON", "code_information": [{"code": "33259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3028.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1014.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6830.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2287.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5769.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1933.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ADD-ON", "code_information": [{"code": "33258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2316.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6546.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2191.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1315.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3211.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4026.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3211.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1227.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4870.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5868.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4870.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5170.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1732.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5803.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1938.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5715.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1915.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 743.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 336.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUPERF", "code_information": [{"code": "30801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 558.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1559.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5562.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1562.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2723.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3558.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2723.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATION-AV NODE", "code_information": [{"code": "93650", "type": "CPT"}, {"code": "4610650", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27821.0, "gross_charge": 35329.0, "discounted_cash": 26496.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 22963.85, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 14131.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2055.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 26496.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 686.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATN RENL TUMORS CRYO", "code_information": [{"code": "5050593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23416.0, "discounted_cash": 17562.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7911.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7911.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2184.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 MAG FLD NDCT", "code_information": [{"code": "739T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5656.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3559.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1194.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 746.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 444.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 746.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 187.22, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 187.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 208.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 189.1, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 189.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 210.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.4, "maximum": 33.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 813.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1361.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1432.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 477.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1569.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2155.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1554.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1816.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 604.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2113.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 860.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10882.3, "maximum": 22995.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11697.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11719.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11321.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10882.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18211.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22995.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9130.63, "maximum": 19294.37, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9308.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9833.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9499.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9130.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15279.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19294.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABOVE KNEE SURGICAL STOCKING", "code_information": [{"code": "A4490", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.74, "maximum": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 492.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 276.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 1419.45, "maximum": 1419.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 1696.57, "maximum": 1696.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1696.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 1689.21, "maximum": 1689.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1689.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 1645.71, "maximum": 1645.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1645.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 1520.99, "maximum": 1520.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1520.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 1554.86, "maximum": 1554.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1554.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 1579.06, "maximum": 1579.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1579.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 1471.38, "maximum": 1471.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1471.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 1546.44, "maximum": 1546.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1546.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 1494.37, "maximum": 1494.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1494.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 1638.35, "maximum": 1638.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1638.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1485.95, "maximum": 1485.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1485.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1554.86, "maximum": 1554.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1554.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 1638.35, "maximum": 1638.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1638.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 1419.45, "maximum": 1419.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 1436.3, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1436.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACAMPROSATE 333MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS OF TRANSEP CYTOL SAMP", "code_information": [{"code": "D0486", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.5, "maximum": 186.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1019.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 344.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS/RETORQ IMPLANT SCREW", "code_information": [{"code": "D6089", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACELLULAR DERM MATRIX IMPLT", "code_information": [{"code": "15777", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 772.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACETABULR COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24622.0, "discounted_cash": 18466.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETABULR SEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 31412.0, "discounted_cash": 23559.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}, {"code": "4100408", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.82, "maximum": 70.7, "gross_charge": 973.0, "discounted_cash": 729.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}, {"code": "4120055", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.82, "maximum": 70.7, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN/2", "code_information": [{"code": "80143", "type": "CPT"}, {"code": "4100386", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.82, "maximum": 70.7, "gross_charge": 901.0, "discounted_cash": 675.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "5318004", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 106.66, "maximum": 106.66, "gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMI UPTO 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}, {"code": "5318004", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 106.66, "maximum": 106.66, "gross_charge": 296.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID 500MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300102", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETIC ACID 2% 15ML OT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330016", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETIC ACID 2% 15ML OT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330016", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETIC ACID 3% 30ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334005", "type": "CDM"}, {"code": "250", "type": "RC"}], 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 70.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 342.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 17.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charges": [{"minimum": 79.65, "maximum": 79.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 129.68, "maximum": 129.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 520.4, "maximum": 520.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.73, "maximum": 205.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD TO SPINAL ORTHOSIS NOS", "code_information": [{"code": "L0999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 312.2, "maximum": 312.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 312.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE DEAMINASE", "code_information": [{"code": "84311", "type": "CPT"}, {"code": "7256366", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.72, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE NEO 5ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 90.0, "discounted_cash": 67.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "5318047", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.28, "maximum": 2.28, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOSINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "5318047", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.28, "maximum": 2.28, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 228.53, "maximum": 228.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 228.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 123.01, "maximum": 123.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADHESIOLYSIS TUBE OVARY", "code_information": [{"code": "58740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3298.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1102.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADHESIVE BANDAGE, FIRST-AID", "code_information": [{"code": "A6413", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1647.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 558.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUST MAX PROST APPLIANCE", "code_information": [{"code": "D5992", "type": "HCPCS"}], "standard_charges": [{"minimum": 446.55, "maximum": 446.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADJUSTMENT GASTRIC BAND", "code_information": [{"code": "S2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1516.0, "maximum": 8718.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADLT DISP UND/PULL ON ABV XL", "code_information": [{"code": "T4544", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1385.73, "maximum": 1385.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1385.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 824.41, "maximum": 824.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"minimum": 677.85, "maximum": 677.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 677.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1139.42, "maximum": 1139.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1139.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM OF SOC DTR ASSESS 5-15 M", "code_information": [{"code": "G0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"minimum": 915.9, "maximum": 915.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 915.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"minimum": 1113.89, "maximum": 1113.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1113.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "1990028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2010028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2050028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2120028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2150028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2160028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2180028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY ADULT LEVEL II", "code_information": [{"code": "2300028", "type": "CDM"}, {"code": "199", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "1990027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2010027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2050027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2120027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2150027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2160027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2180027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN DAY LEVEL I", "code_information": [{"code": "2300027", "type": "CDM"}, {"code": "169", "type": "RC"}], "standard_charges": [{"gross_charge": 5580.0, "discounted_cash": 4185.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN RSV MONOC ANTB IM CNSL", "code_information": [{"code": "96380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADMN SARSCOV2 VACC 1 DOSE", "code_information": [{"code": "90480", "type": "CPT"}], "standard_charges": [{"minimum": 161.92, "maximum": 161.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADPTR MOLD HIP SPCR NECK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4010671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18230.0, "discounted_cash": 13672.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR", "code_information": [{"code": "717T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRC THER PRTL RC TEAR NJX", "code_information": [{"code": "718T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23787.61, "maximum": 50266.74, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35900.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25617.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24747.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23787.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39807.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50266.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15186.6, "maximum": 32091.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20750.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16355.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15799.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15186.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25414.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32091.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL IMG CORTX/MEDULA", "code_information": [{"code": "78075", "type": "CPT"}, {"code": "5208075", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1807.72, "gross_charge": 4306.0, "discounted_cash": 3229.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 433.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 715.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1626.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - 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"standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENALIN EPINEPHRINE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.84, "maximum": 2.84, "estimated_discounted_cash": 630.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 898.13, "maximum": 4951.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 898.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 998.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4951.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1174.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADULT DISP BRIEF/DIAP ABV XL", "code_information": [{"code": "T4543", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4523", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER MED", "code_information": [{"code": "T4522", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER SM", "code_information": [{"code": "T4521", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE BRIEF/DIAPER XL", "code_information": [{"code": "T4524", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON LG", "code_information": [{"code": "T4527", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON MED", "code_information": [{"code": "T4526", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ADULT SIZE PULL-ON SM", "code_information": [{"code": "T4525", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 258.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 248.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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{"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20239.76, "maximum": 42769.62, "estimated_discounted_cash": 149316.79, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27032.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21796.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21056.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20239.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33870.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42769.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8724.73, "maximum": 18436.64, "estimated_discounted_cash": 99080.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9743.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9395.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9076.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.88, "maximum": 54.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AI DS SLE ALYS 8 IGG AUTOANT", "code_information": [{"code": "312U", "type": "CPT"}], "standard_charges": [{"minimum": 578.39, "maximum": 3188.59, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 578.39, "methodology": 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{"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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"code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBENDAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300201", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.53, "maximum": 80.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.26, "maximum": 40.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 25% PER 50ML IJ", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "5318063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 201.32, "maximum": 201.32, "gross_charge": 1116.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 25% PER 50ML IJ", "code_information": [{"code": "P9047", "type": "HCPCS"}, {"code": "5318063", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 201.32, "maximum": 201.32, "gross_charge": 1116.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 250ML IJ", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "5318032", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 201.32, "maximum": 201.32, "gross_charge": 1566.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN 5% PER 250ML IJ", "code_information": [{"code": "P9045", "type": "HCPCS"}, {"code": "5318032", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 201.32, "maximum": 201.32, "gross_charge": 1566.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN QUANT OTH SRC", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "4172045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.51, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA 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459.0, "discounted_cash": 344.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.66, "maximum": 0.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.57, 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{"description": "ALBUTEROL PER DOSE IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330124", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL/IPRATR 3ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee 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45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL2.5MG/.5ML UDIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330125", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL OR PEROXIDE PER PINT", "code_information": [{"code": "A4244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", 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"methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1571.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 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{"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 130430.27, "maximum": 275618.52, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 160088.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 140465.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 135694.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 130430.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 218269.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", 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3.79, "gross_charge": 3641.0, "discounted_cash": 2730.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "4020507", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3641.0, "discounted_cash": 2730.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4020523", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62882.0, "discounted_cash": 47161.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4020523", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62882.0, "discounted_cash": 47161.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4020525", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 25502.0, "discounted_cash": 19126.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC MEMBRN", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4020525", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 25502.0, "discounted_cash": 19126.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC TISSUE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "4020514", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12542.0, "discounted_cash": 9406.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT AMNIOTIC TISSUE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "4020514", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12542.0, "discounted_cash": 9406.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT BN W/VIAB CELLS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4020510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40125.0, "discounted_cash": 30093.75, 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"C1762", "type": "HCPCS"}, {"code": "4020580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2995.0, "discounted_cash": 2246.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRFT SCLERA TUTOPLST", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "4020518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 6504.0, "discounted_cash": 4878.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRFT TENDON PRESUTUR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4020587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40396.0, "discounted_cash": 30297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOGRFT TENFUSE PIP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4027060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12567.0, "discounted_cash": 9425.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOMEND DRM MAT ALLOSOURCE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4020481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12834.0, "discounted_cash": 9625.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOPATCH PLIABL 6X8 PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4027066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 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{"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.39, "maximum": 257.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPROSTADL PER1.25MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}, {"code": "5318074", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 33.34, "maximum": 33.34, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPROSTADL PER1.25MCG IJ", 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{"description": "AMNIOBAND 10MM DISK PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020613", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 851.0, "discounted_cash": 638.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 14MM DISK PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020601", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 1490.0, "discounted_cash": 1117.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 14MM DISK PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020601", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 1490.0, "discounted_cash": 1117.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 18MM DISK PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020608", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 2980.0, "discounted_cash": 2235.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 18MM DISK PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020608", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 2980.0, "discounted_cash": 2235.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020603", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 4179.0, "discounted_cash": 3134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020603", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 4179.0, "discounted_cash": 3134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX3CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020611", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 5003.0, "discounted_cash": 3752.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX3CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020611", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 5003.0, "discounted_cash": 3752.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020602", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 4643.0, "discounted_cash": 3482.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020602", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 4643.0, "discounted_cash": 3482.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 3CMX4CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020605", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 5221.0, "discounted_cash": 3915.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND 3CMX4CM PER SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}, {"code": "4020605", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 503.99, "maximum": 503.99, "gross_charge": 5221.0, "discounted_cash": 3915.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND PER 1MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}, {"code": "4020593", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 65.45, "maximum": 65.45, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND PER 1MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}, {"code": "4020593", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 65.45, "maximum": 65.45, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 292.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 214.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCORE PER SQ CM", "code_information": [{"code": "Q4227", "type": "HCPCS"}], "standard_charges": [{"minimum": 364.84, "maximum": 364.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 364.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOEFFECT LYOPHILIZED AMNION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "4027040", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 28035.0, "discounted_cash": 21026.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOEFFECT LYOPHILIZED AMNION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "4027040", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 28035.0, "discounted_cash": 21026.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"minimum": 431.18, "maximum": 431.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 431.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOMATRIX INJ 2ML PER 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "4020579", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10072.0, "discounted_cash": 7554.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOMATRIX INJ 2ML PER 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "4020579", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 10072.0, "discounted_cash": 7554.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOMATRIX PER 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "4020591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11965.0, "discounted_cash": 8973.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOMATRIX PER 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}, {"code": "4020591", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 11965.0, "discounted_cash": 8973.75, "setting": "both", "billing_class": "facility"}]}, {"description": "AMNIOREPAIR OR ALTIPLY SQ CM", "code_information": [{"code": "Q4235", "type": "HCPCS"}], "standard_charges": [{"minimum": 557.81, "maximum": 557.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 557.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT PATCH, PER SQ CM", "code_information": [{"code": "Q4247", "type": "HCPCS"}], "standard_charges": [{"minimum": 2010.29, "maximum": 2010.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2010.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300750", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300750", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314319", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314319", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN PER 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "5318265", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.83, "maximum": 3.83, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN PER 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}, {"code": "5318265", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.83, "maximum": 3.83, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2689.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 901.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2386.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 798.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2831.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 943.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3528.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1186.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2425.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2512.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 845.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATE METACARPAL BONE", "code_information": [{"code": "26910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2804.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 934.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3410.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.33, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2109.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 709.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2844.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 956.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2275.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 764.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2527.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 850.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2627.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 879.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2217.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 745.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2936.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 974.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1840.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 617.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2578.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2102.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 704.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2353.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 787.87, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [{"code": "240", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30936.48, "maximum": 65373.37, "estimated_discounted_cash": 156997.04, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40201.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33316.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32185.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30936.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51770.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 65373.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [{"code": "239", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53415.21, "maximum": 112874.27, "estimated_discounted_cash": 312828.99, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 69333.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57524.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55570.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 53415.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 89387.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 112874.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC", "code_information": [{"code": "241", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15024.89, "maximum": 31749.83, "estimated_discounted_cash": 100628.3, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20558.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16180.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15631.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15024.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25143.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31749.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24698.17, "maximum": 52190.9, "estimated_discounted_cash": 357492.1, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29872.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26598.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25694.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24698.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41331.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52190.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 46590.84, "maximum": 98453.37, "estimated_discounted_cash": 242141.29, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 52365.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 50175.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 48471.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46590.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77967.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 98453.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "476", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12808.71, "maximum": 27066.71, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16298.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13794.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13325.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12808.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21434.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27066.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2592.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FINGER/THUMB", "code_information": [{"code": "26952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2520.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 838.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2066.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 691.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2321.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2644.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 893.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2588.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 869.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4261.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1431.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3170.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1054.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5911.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1984.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4593.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1532.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3242.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1083.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3047.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1003.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2136.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [{"code": "617", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20298.37, "maximum": 42893.46, "estimated_discounted_cash": 197494.97, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29073.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21860.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21117.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20298.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33968.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42893.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "616", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37848.75, "maximum": 79980.03, "estimated_discounted_cash": 260320.33, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60623.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 40760.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39376.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37848.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63338.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 79980.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "618", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15392.81, "maximum": 32527.29, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19685.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16577.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16014.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15392.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25759.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32527.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1935.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 649.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 18251.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 646.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 357.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2720.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 945.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2699.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.8, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 41934.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2579.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 864.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 56444.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1548.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "4102150", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.58, "gross_charge": 535.0, "discounted_cash": 401.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "4122150", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.58, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, 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{"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1255.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESIA", "code_information": [{"code": "D9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.94, "maximum": 61.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 19.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NONOPIOD 1-2", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "4150026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NONOPIOD 1-2", "code_information": [{"code": "80329", "type": "CPT"}, {"code": "4170061", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NONOPIOD 6+", "code_information": [{"code": "80331", "type": "CPT"}, {"code": "7250384", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 30.91, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 424.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 195.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 105.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 116.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 424.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS OF SALIVA SAMPLE", "code_information": [{"code": "D0418", "type": "HCPCS"}], "standard_charges": [{"minimum": 213.13, "maximum": 213.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 323.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 33.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 64.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE SPINE INFUS PUMP", "code_information": [{"code": "62367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 24.14, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMIC DEV", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8151000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8073.0, "discounted_cash": 6054.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6340.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2119.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1 MG", "code_information": [{"code": "S0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.81, "maximum": 21.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTROZOLE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300762", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}, {"code": "7250245", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.29, "maximum": 45.71, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH ARTHRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8170060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH BIO-SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15438.0, "discounted_cash": 11578.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH BIO-SWVLK C DBL #2 TIGRTL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4388.0, "discounted_cash": 3291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH BONE W/ARTHRO DELY SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6368.0, "discounted_cash": 4776.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH CORKSCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2530.0, "discounted_cash": 1897.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH LEAD SPINL STIM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8178125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3561.0, "discounted_cash": 2670.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCH LINK KNOTLS QUATTRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3407.0, "discounted_cash": 2555.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH NEUROSTIM LD SWFT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8170075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1334.0, "discounted_cash": 1000.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH PEEK PUSH LCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4072.0, "discounted_cash": 3054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH QUICK MITEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8176200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7475.0, "discounted_cash": 5606.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SCRW BIO-INTRAFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2292.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SLEEVE LEAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8140996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT ALL Q-FIX 1.8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6867.0, "discounted_cash": 5150.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT BIO-SUTURETAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4020700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3355.0, "discounted_cash": 2516.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT BIOCRKSCRW FT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3697.0, "discounted_cash": 2772.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT COMPOSITCP BB TAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3653.0, "discounted_cash": 2739.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT FBRTAK W/SUTRTP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4648.0, "discounted_cash": 3486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT FOOTPRINT ULTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2579.0, "discounted_cash": 1934.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT HEALICOIL KNOTLESS SN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3666.0, "discounted_cash": 2749.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT INTELL FRC FIBR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1789.0, "discounted_cash": 1341.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT KNOTLESS FIBERTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4801.0, "discounted_cash": 3600.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT KNOTLS SUTURTK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4388.0, "discounted_cash": 3291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT MINI BIOCOMPSTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12607.0, "discounted_cash": 9455.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT SHORT SFT W/NDL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3461.0, "discounted_cash": 2595.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT SWVLCK PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22331.0, "discounted_cash": 16748.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT SWVLK TENODESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4491.0, "discounted_cash": 3368.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUT TWINFIX TITAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3158.0, "discounted_cash": 2368.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH SUTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8170090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7744.0, "discounted_cash": 5808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH VERSALOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4010720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3139.0, "discounted_cash": 2354.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TIS/BN10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4854.0, "discounted_cash": 3640.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TIS/BN11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4131.0, "discounted_cash": 3098.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12391.0, "discounted_cash": 9293.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8779.0, "discounted_cash": 6584.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5575.0, "discounted_cash": 4181.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 2285.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26847.0, "discounted_cash": 20135.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20678.0, "discounted_cash": 15508.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCH/SCRW BN/BN TISS/BN9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8240021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4686.0, "discounted_cash": 3514.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 21.74, "maximum": 119.86, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 119.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 109.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 30.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 33.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 109.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}, {"code": "7252157", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.06, "gross_charge": 437.0, "discounted_cash": 327.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 56.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 30.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"minimum": 382.33, "maximum": 382.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP EMERGENCY COND", "code_information": [{"code": "99140", "type": "CPT"}], "standard_charges": [{"minimum": 152.93, "maximum": 152.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"minimum": 382.33, "maximum": 382.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"minimum": 76.47, "maximum": 76.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIA EA ADD 15 MIN", "code_information": [{"code": "3703561", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANESTHESIA INIT 30 MIN", "code_information": [{"code": "3703560", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 1541.0, "discounted_cash": 1155.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANESTHESIOLOGY SS", "code_information": [{"code": "G0061", "type": "HCPCS"}], "standard_charges": [{"minimum": 5708.96, "maximum": 5708.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5708.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7617.72, "maximum": 16097.37, "estimated_discounted_cash": 36010.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8248.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8203.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7925.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7617.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12747.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16097.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIO ADRENAL UNILAT SEL", "code_information": [{"code": "75731", "type": "CPT"}, {"code": "4915732", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 21402.0, "discounted_cash": 16051.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1076.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 189.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 848.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 942.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 362.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXIST CATH F/U STU", "code_information": [{"code": "75898", "type": "CPT"}, {"code": "4915898", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 4.13, "maximum": 2861.66, "gross_charge": 8701.0, "discounted_cash": 6525.75, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 196.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 218.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY BILAT", "code_information": [{"code": "75716", "type": "CPT"}, {"code": "4615718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 7583.0, "discounted_cash": 5687.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1100.63, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 962.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1069.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY BILAT", "code_information": [{"code": "75716", "type": "CPT"}, {"code": "4905718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 17084.0, "discounted_cash": 12813.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1100.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 962.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1069.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY BILAT", "code_information": [{"code": "75716", "type": "CPT"}, {"code": "4915718", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 7583.0, "discounted_cash": 5687.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1100.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 962.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1069.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO EXTREMITY UNILAT", "code_information": [{"code": "75710", "type": "CPT"}, {"code": "4615712", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 13996.0, "discounted_cash": 10497.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1080.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 849.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 944.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee 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"standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 849.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 944.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": 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"standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 849.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 944.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO FEM/POP W/ US", "code_information": [{"code": "C7531", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": 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"code_information": [{"code": "4916234", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIO PELVIC SELECT/SUP", "code_information": [{"code": "75736", "type": "CPT"}, {"code": "4915737", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "gross_charge": 9280.0, "discounted_cash": 6960.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1076.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 173.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 839.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 933.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 335.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULM NON-SEL CATH", "code_information": [{"code": "75746", "type": "CPT"}, {"code": "4615747", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 3547.0, "discounted_cash": 2660.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1068.11, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULM NON-SEL CATH", "code_information": [{"code": "75746", "type": "CPT"}, {"code": "4915747", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 5508.0, "discounted_cash": 4131.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULM SEL BI", "code_information": [{"code": "75743", "type": "CPT"}, {"code": "4615744", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 11225.0, "discounted_cash": 8418.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1064.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 147.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 785.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 872.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULM SEL BI - OR", "code_information": [{"code": "75743", "type": "CPT"}, {"code": "4905743", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 10298.0, "discounted_cash": 7723.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1064.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 147.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 785.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 872.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULMONARY UNI SLCT", "code_information": [{"code": "75741", "type": "CPT"}, {"code": "4615742", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 10577.0, "discounted_cash": 7932.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 145.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 750.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 256.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO PULMONARY UNI SLCT", "code_information": [{"code": "75741", "type": "CPT"}, {"code": "4915742", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 6487.0, "discounted_cash": 4865.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 145.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 750.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 256.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SELECT EA ADD VESL", "code_information": [{"code": "75774", "type": "CPT"}, {"code": "4613540", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1052.35, "gross_charge": 5801.0, "discounted_cash": 4350.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1052.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 701.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 778.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SELECT EA ADD VESL", "code_information": [{"code": "75774", "type": "CPT"}, {"code": "4915775", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1052.35, "gross_charge": 5801.0, "discounted_cash": 4350.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1052.35, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 701.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 778.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO SPINAL SELECTIVE", "code_information": [{"code": "75705", "type": "CPT"}, {"code": "4915706", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "gross_charge": 17084.0, "discounted_cash": 12813.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 998.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 839.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 933.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 492.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO VISCERAL SEL/SUPSEL", "code_information": [{"code": "75726", "type": "CPT"}, {"code": "4905726", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "gross_charge": 9280.0, "discounted_cash": 6960.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1073.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 155.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 834.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 927.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 281.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO VISCERAL SEL/SUPSEL", "code_information": [{"code": "75726", "type": "CPT"}, {"code": "4915729", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "gross_charge": 14374.0, "discounted_cash": 10780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1073.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 155.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 834.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 927.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 281.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO W/ US NON-CORONARY", "code_information": [{"code": "C7532", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIOPLASTY FIBRIN SHEATH", "code_information": [{"code": "4913799", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3800.0, "discounted_cash": 2850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 169.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN CONV ENZYME", "code_information": [{"code": "82164", "type": "CPT"}, {"code": "7252164", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.38, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.34, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART EA ADDL", "code_information": [{"code": "4617247", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16806.0, "discounted_cash": 12604.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART INIT+S&I", "code_information": [{"code": "4617246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45351.0, "discounted_cash": 34013.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY ART INIT+S&I", "code_information": [{"code": "4917246", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 45351.0, "discounted_cash": 34013.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN EA ADDL", "code_information": [{"code": "4917249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20363.0, "discounted_cash": 15272.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN INIT+S&I", "code_information": [{"code": "4617248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20363.0, "discounted_cash": 15272.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIPLASTY VEN INIT+S&I", "code_information": [{"code": "4917248", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20363.0, "discounted_cash": 15272.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN PER 1 MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}, {"code": "5318330", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1.74, "maximum": 1.74, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN PER 1 MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}, {"code": "5318330", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.74, "maximum": 1.74, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE 2 VIEWS", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "4903600", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.67, "gross_charge": 2377.0, "discounted_cash": 1782.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 84.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE 3 VIEWS MINIMUM", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "4903610", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.2, "gross_charge": 2572.0, "discounted_cash": 1929.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 56.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 99.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 110.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2481.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 834.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2363.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 794.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1857.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1705.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1823.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 609.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2061.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 692.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3678.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1226.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANL SP INF PMP W/MDREPRG&FIL", "code_information": [{"code": "62370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOGENITAL EXAM CHILD W IMAG", "code_information": [{"code": "99170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 307.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 307.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 200.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 292.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 263.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 329.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 213.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 329.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 213.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 240.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 600.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 739.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 600.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 234.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 199.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 342.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 203.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 324.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 203.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 345.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 246.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 246.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 239.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 75.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT RESIN-BASED CMPST CROWN", "code_information": [{"code": "D2390", "type": "HCPCS"}], "standard_charges": [{"minimum": 576.0, "maximum": 576.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 412.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 412.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 131.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG 8+", "code_information": [{"code": "22837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6905.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2307.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6269.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2094.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTACID K/NA BICAR EFFTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANTACID K/NA BICAR EFFTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 28.2, "maximum": 118.83, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEGRADE NEPHROSTOGRAM", "code_information": [{"code": "74425", "type": "CPT"}, {"code": "4904425", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 407.94, "gross_charge": 3461.0, "discounted_cash": 2595.75, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 253.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 407.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEGRADE NEPHROSTOGRAM", "code_information": [{"code": "74425", "type": "CPT"}, {"code": "4914425", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 407.94, "gross_charge": 2939.0, "discounted_cash": 2204.25, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 253.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 407.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1568.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 681.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 247.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1247.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 247.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 371.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPHY", "code_information": [{"code": "57240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 27705.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2249.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 749.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 450.61, "maximum": 450.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-GLOMERULAR BSMNT", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "7252322", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.73, "gross_charge": 1012.0, "discounted_cash": 759.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.6, "maximum": 8.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-NEUTRPHL CYTOPLASM", "code_information": [{"code": "86036", "type": "CPT"}, {"code": "7250241", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.29, "maximum": 45.71, "gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-STREPTOLYSN O TITER", "code_information": [{"code": "86060", "type": "CPT"}, {"code": "7256060", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.69, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-XA", "code_information": [{"code": "85130", "type": "CPT"}, {"code": "7250406", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.1, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBDY IDENT RBC EA PNL", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "4106024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.56, "maximum": 262.13, "gross_charge": 1752.0, "discounted_cash": 1314.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIBDY 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"HUMANA COMMERCIAL", "standard_charge_dollar": 3459.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIVEN CROTAL IMM FAB 2 EQ IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0841", "type": "HCPCS"}, {"code": "5319635", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3459.5, "maximum": 3459.5, "gross_charge": 5534.0, "discounted_cash": 4150.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3459.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIVEN CROTAL PER1GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0840", "type": "HCPCS"}, {"code": "5319634", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 7396.04, "maximum": 7396.04, "gross_charge": 31110.0, "discounted_cash": 23332.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7396.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIVEN CROTAL PER1GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0840", "type": "HCPCS"}, {"code": "5319634", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7396.04, "maximum": 7396.04, "gross_charge": 31110.0, "discounted_cash": 23332.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7396.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT 1ST GD", "code_information": [{"code": "561T", "type": "CPT"}], "standard_charges": [{"minimum": 55.66, "maximum": 264.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC GUIDE 3D PRINT EA ADDL", "code_information": [{"code": "562T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT 1ST CMPNT", "code_information": [{"code": "559T", "type": "CPT"}], "standard_charges": [{"minimum": 55.66, "maximum": 55.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTMC MDL 3D PRINT EA ADDL", "code_information": [{"code": "560T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORT/INF/IV/BPG COMP", "code_information": [{"code": "93978", "type": "CPT"}, {"code": "5062020", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 519.03, "gross_charge": 2366.0, "discounted_cash": 1774.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 170.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORT/IVC/IV/BPG UNI/LTD", "code_information": [{"code": "93979", "type": "CPT"}, {"code": "5067150", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 343.61, "gross_charge": 1213.0, "discounted_cash": 909.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 343.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [{"code": "268", "type": "MS-DRG"}], "standard_charges": [{"minimum": 66010.0, "maximum": 157737.76, "estimated_discounted_cash": 766735.98, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66010.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80388.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 77658.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 74645.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 124916.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157737.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45834.39, "maximum": 96854.87, "estimated_discounted_cash": 423867.01, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66010.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 49360.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47684.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 45834.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76701.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 96854.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1247.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 416.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2530.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 844.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 453.6, "maximum": 1911.67, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 456.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 507.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1911.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 1215.17, "maximum": 5121.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1222.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1358.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5121.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1215.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3246.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1085.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3520.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1177.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AORTIC VALVE #2", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8141010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 89319.0, "discounted_cash": 66989.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APA/ASA/CAF ES TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APA/ASA/CAF ES TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300011", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 120MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338016", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 120MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338016", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 10.15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314018", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 10.15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314018", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314023", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 2.5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314027", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 160M/5M 2.5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314027", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 325MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338020", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 325MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338020", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300017", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300017", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 500MG ES TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300014", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 500MG ES TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5300014", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 650MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338024", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP 650MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338024", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APAP NOS PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0131", "type": "HCPCS"}, {"code": "5318338", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.17, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP NOS PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0131", "type": "HCPCS"}, {"code": "5318338", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.17, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/BUT/CAF/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327037", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/BUT/CAF/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327037", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/BUTAL/CAF/ TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/BUTAL/CAF/ TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327036", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 12ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327009", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 12ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327009", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 120/12 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327011", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327019", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327019", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APAP/COD 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327023", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 180.0, "maximum": 758.6, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 232.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 258.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 758.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 226.48, "maximum": 2958.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 226.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 251.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2958.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 77.43, "maximum": 1062.04, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 77.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 86.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1062.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 192.7, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 192.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 214.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC FINAL", "code_information": [{"code": "D3353", "type": "HCPCS"}], "standard_charges": [{"minimum": 807.15, "maximum": 807.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 807.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INITIAL", "code_information": [{"code": "D3351", "type": "HCPCS"}], "standard_charges": [{"minimum": 504.62, "maximum": 504.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 504.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INTERIM", "code_information": [{"code": "D3352", "type": "HCPCS"}], "standard_charges": [{"minimum": 383.59, "maximum": 383.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 42.22, "maximum": 42.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 307.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1768.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2585.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1768.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 336.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 599.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 828.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 599.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 130.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 128.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 401.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 134.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APICALLY POSITIONED FLAP", "code_information": [{"code": "D4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1055.17, "maximum": 1055.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1055.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APICOECTOMY - ANTERIOR", "code_information": [{"code": "D3410", "type": "HCPCS"}], "standard_charges": [{"minimum": 918.36, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 918.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300772", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIXABAN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300772", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIXABAN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300771", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APIXABAN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300771", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APLIGRAF PER SQ CM", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "8240451", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 115.31, "maximum": 115.31, "gross_charge": 311.0, "discounted_cash": 233.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APLIGRAF PER SQ CM", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "8240451", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 115.31, "maximum": 115.31, "gross_charge": 311.0, "discounted_cash": 233.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOL1 RISK VARIANTS", "code_information": [{"code": "355U", "type": "CPT"}], "standard_charges": [{"minimum": 93.33, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 93.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOLIPOPROTEIN", "code_information": [{"code": "82172", "type": "CPT"}, {"code": "7252172", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.99, "gross_charge": 231.0, "discounted_cash": 173.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 30.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.23, "maximum": 115.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 25SC", "code_information": [{"code": "6900018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8438.0, "discounted_cash": 6328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG 1ST 25SC", "code_information": [{"code": "6900018", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 8438.0, "discounted_cash": 6328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 25SC", "code_information": [{"code": "6900017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB FNHG EA ADL 25SC", "code_information": [{"code": "6900017", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 25SC", "code_information": [{"code": "6900023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8438.0, "discounted_cash": 6328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L 1ST 25SC", "code_information": [{"code": "6900023", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 8438.0, "discounted_cash": 6328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L EA ADL 25SC", "code_information": [{"code": "6900022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP LC SKNSB T/A/L EA ADL 25SC", "code_information": [{"code": "6900022", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "estimated_discounted_cash": 402.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4257.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1425.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6429.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2047.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 25SC", "code_information": [{"code": "6900029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11625.0, "discounted_cash": 8718.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G 1ST 25SC", "code_information": [{"code": "6900029", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 11625.0, "discounted_cash": 8718.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G EA ADL 25SC", "code_information": [{"code": "6900030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB F/N/H/G EA ADL 25SC", "code_information": [{"code": "6900030", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL25SC", "code_information": [{"code": "6900026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L ADL25SC", "code_information": [{"code": "6900026", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 3168.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L<1ST 25SC", "code_information": [{"code": "6900025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11625.0, "discounted_cash": 8718.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP SKNSUB GRFT T/A/L<1ST 25SC", "code_information": [{"code": "6900025", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 11625.0, "discounted_cash": 8718.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 35.58, "maximum": 35.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2333.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 781.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3181.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 299.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4553.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4553.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1528.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH CC", "code_information": [{"code": "398", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16427.1, "maximum": 34712.9, "estimated_discounted_cash": 89593.78, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17690.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17090.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16427.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27490.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34712.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25991.85, "maximum": 54924.64, "estimated_discounted_cash": 102040.8, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27991.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27040.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25991.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43496.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54924.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "399", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12423.43, "maximum": 26252.55, "estimated_discounted_cash": 89421.17, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13379.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12924.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12423.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20790.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26252.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL DESENSITIZING RESIN", "code_information": [{"code": "D9911", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.15, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3265.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1097.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4135.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1392.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.68, "estimated_discounted_cash": 299.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 94.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [{"code": "20690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2185.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 735.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLIANCE REMOVAL", "code_information": [{"code": "D7997", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.3, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO CRANIAL", "code_information": [{"code": "20661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1933.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 638.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1781.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 598.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1927.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 649.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LONG LEG SPLINT", "code_information": [{"code": "29505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1757.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 191.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 114.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOWER LEG SPLINT", "code_information": [{"code": "29515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1765.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 725.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 586.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 658.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 376.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 526.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 633.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 377.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 611.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 369.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 686.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 404.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 255.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 849.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FOREARM CAST", "code_information": [{"code": "29075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 316.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 411.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 179.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM CAST", "code_information": [{"code": "29065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 361.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 169.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 387.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2177.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 842.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 147.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 247.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RADIAT COMPL", "code_information": [{"code": "77778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1684.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 593.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 479.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1165.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1295.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1684.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1256.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 539.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 471.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1130.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1256.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1201.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 408.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 971.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 427.65, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 364.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 874.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 971.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 920.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 826.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 323.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 316.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 826.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 801.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1739.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 376.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "5709579", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 1535.0, "discounted_cash": 1151.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "6900091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1535.0, "discounted_cash": 1151.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY ML COMPRS LWR LEG", "code_information": [{"code": "6900091", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1535.0, "discounted_cash": 1151.25, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1825.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5859.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5859.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1957.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 865.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "6900090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1853.0, "discounted_cash": 1389.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "6900090", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1853.0, "discounted_cash": 1389.75, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1793.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 359.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 157.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 214.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 94.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 316.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 542.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 267.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 76.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 99.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 224.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 249.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 267.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APRACLONIDINE .5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330211", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APRACLONIDINE .5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330211", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 658.0, "discounted_cash": 493.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APRACLONIDINE 1% .1ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 351.0, "discounted_cash": 263.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APREPITANT 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8501", "type": "HCPCS"}, {"code": "5300774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 16.03, "maximum": 16.03, "gross_charge": 159.0, "discounted_cash": 119.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APREPITANT 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8501", "type": "HCPCS"}, {"code": "5300774", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.03, "maximum": 16.03, "gross_charge": 159.0, "discounted_cash": 119.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.05, "maximum": 10.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 8.29, "maximum": 143.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 380.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 380.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 AB ELISA", "code_information": [{"code": "86051", "type": "CPT"}, {"code": "7250243", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.92, "maximum": 43.73, "gross_charge": 1045.0, "discounted_cash": 783.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN 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EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 8.29, "maximum": 45.71, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY/EXERCISES", "code_information": [{"code": "97113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4126.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1371.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3917.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1302.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 207.34, "maximum": 1143.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 207.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1143.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 1143.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 272.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 303.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1143.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL15MCG/2ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330217", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.91, "maximum": 6.91, "setting": "outpatient", 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"setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300777", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300786", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300786", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300783", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300783", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.88, "maximum": 2.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE LAUROXIL 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1944", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.79, "maximum": 11.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARSENIC", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "7252158", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.95, "gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARSENIC TRIOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9017", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.86, "maximum": 59.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6544.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2175.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5618.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5618.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1889.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6124.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2058.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6019.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2005.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5475.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5475.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1809.58, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5858.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1957.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4816.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4816.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1610.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3612.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3874.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1290.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4646.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4646.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4157.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1385.23, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3502.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1171.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4947.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4947.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1659.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5864.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5864.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1954.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4551.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1514.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3827.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1277.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3789.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1262.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6129.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6129.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2051.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6885.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2298.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8619.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8619.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2877.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8241.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8241.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2752.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7736.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7736.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2582.7, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7359.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7359.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2456.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6022.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2011.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4133.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1381.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4343.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1451.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5326.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5326.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1778.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4036.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1349.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4004.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1299.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4350.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1453.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4346.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1451.29, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4699.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4699.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1571.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4984.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4984.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1665.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4381.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1442.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4919.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4919.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1642.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6720.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2243.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4637.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4637.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1544.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4681.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4681.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1564.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5154.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5154.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1720.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5969.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5969.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1994.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4312.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1440.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4261.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1423.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4500.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4500.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1504.62, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3960.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1322.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4699.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4699.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1571.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6380.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2130.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6998.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6998.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2329.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4150.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1382.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4311.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1440.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6243.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2084.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4673.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1559.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4007.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1329.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5634.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5634.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1882.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3895.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1301.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3702.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1236.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3354.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1120.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5209.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1739.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART OR VENOUS BLOOD TUBING", "code_information": [{"code": "A4750", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.27, "maximum": 30.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3629.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1213.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3498.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1169.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2971.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 993.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3350.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1119.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC 1 SQ CM", "code_information": [{"code": "Q4190", "type": "HCPCS"}], "standard_charges": [{"minimum": 1676.95, "maximum": 1676.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1676.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC, 1 MG", "code_information": [{"code": "Q4189", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.68, "maximum": 80.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTACENT WOUND, PER SQ CM", "code_information": [{"code": "Q4169", "type": "HCPCS"}], "standard_charges": [{"minimum": 667.78, "maximum": 667.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTEMETHER-LUMEFANT 20-120 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300860", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTEMETHER-LUMEFANT 20-120 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5300860", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERIAL CANNULATION", "code_information": [{"code": "5502005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG CAR NKHD SEL", "code_information": [{"code": "4916226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG EXT CAR SEL", "code_information": [{"code": "4916232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG SUBC/INOM", "code_information": [{"code": "4916228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOG VERT SEL", "code_information": [{"code": "4916230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR HD SEL", "code_information": [{"code": "4616224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR HD SEL", "code_information": [{"code": "4916224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17708.0, "discounted_cash": 13281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERIOGR CAR NK SEL", "code_information": [{"code": "4616222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16397.0, "discounted_cash": 12297.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTEROGRAM ARCH NON SEL", "code_information": [{"code": "4616221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22979.0, "discounted_cash": 17234.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 732.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1740.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2802.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 938.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 998.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 197.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1087.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 407.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 136.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1087.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 184.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 858.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 953.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 130.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 68849.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2814.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 937.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 53368.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2363.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 789.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTESUNATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}, {"code": "5318371", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 150.24, "maximum": 150.24, "gross_charge": 147.0, "discounted_cash": 110.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 150.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTESUNATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}, {"code": "5318371", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 150.24, "maximum": 150.24, "gross_charge": 147.0, "discounted_cash": 110.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 150.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHR SI JT OPN B1GRF INSTRM", "code_information": [{"code": "27280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4954.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1666.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 2-3 VRT SGM", "code_information": [{"code": "22808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6653.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2214.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7293.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2448.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 8+ VRT SGM", "code_information": [{"code": "22812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7993.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7993.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2683.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD CERVICAL EA", "code_information": [{"code": "22552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1423.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 476.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC CRV", "code_information": [{"code": "22554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4609.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1545.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC EA", "code_information": [{"code": "22585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1166.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC LUM", "code_information": [{"code": "22558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5551.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1860.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBD MIN DSC THC", "code_information": [{"code": "22556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6140.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2057.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT NTRBDY CERVICAL", "code_information": [{"code": "22551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6188.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2072.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7171.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2402.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC EA ADDL", "code_information": [{"code": "22634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1740.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD CMBN 1NTRSPC LUMBAR", "code_information": [{"code": "22633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6578.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2207.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4692.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1576.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5973.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2005.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ EA AD", "code_information": [{"code": "22534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1295.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6054.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2031.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ THRC", "code_information": [{"code": "22532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6532.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2186.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7416.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2484.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 13+ VRT SGM", "code_information": [{"code": "22804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8836.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8836.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2947.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM 7-12 VRT SGM", "code_information": [{"code": "22802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7702.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7702.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2567.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST DFRM<6 VRT SGM", "code_information": [{"code": "22800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4990.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1676.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC CRV", "code_information": [{"code": "22600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4769.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1600.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC EA ADD", "code_information": [{"code": "22614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1405.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 470.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LM EA", "code_information": [{"code": "22632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1153.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 385.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUM", "code_information": [{"code": "22630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5688.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1909.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LUMBAR", "code_information": [{"code": "22612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5758.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1928.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC THRC", "code_information": [{"code": "22610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4689.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1576.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ ATLAS-AXIS", "code_information": [{"code": "22595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5555.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1863.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5809.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PERQ/MIN NVAS", "code_information": [{"code": "27279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2926.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 985.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PRQ WO TFXJ DEV", "code_information": [{"code": "27278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1711.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14728.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 307.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 102.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRO/SHOUL SURG; W/SPACER", "code_information": [{"code": "C9781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 12683.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JT", "code_information": [{"code": "23800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3762.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1263.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5825.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1955.87, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3159.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1061.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARTHROEREISIS, SUBTALAR", "code_information": [{"code": "S2117", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX PER SQ CM", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "4020720", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 1201.0, "discounted_cash": 900.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX PER SQ CM", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "4020720", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 1201.0, "discounted_cash": 900.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY", "code_information": [{"code": "509", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22573.21, "maximum": 22573.21, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22573.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDER, SURGI", "code_information": [{"code": "S2300", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBOW W/SYNOVECTOMY", "code_information": [{"code": "24102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2283.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW CAPSL EXC RLS", "code_information": [{"code": "24006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2634.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW EXPL DRG/RMVL FB", "code_information": [{"code": "24000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1776.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 598.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW JT EXPL BX RMVL", "code_information": [{"code": "24101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1868.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 628.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW SYNOVIAL BX ONLY", "code_information": [{"code": "24100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1565.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTICULAR COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32010.0, "discounted_cash": 24007.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12011.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12011.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4016.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8634.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8634.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2887.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASA 300MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338095", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 300MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338095", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 325MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301108", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 325MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301108", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301113", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301113", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 81MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301110", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 81MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301110", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 81MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301109", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA 81MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301109", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA BUFFERED 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA BUFFERED 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301112", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASA/BUTAL/CAFF CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327164", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASA/BUTAL/CAFF CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327164", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASAY OF INTERLEUKIN-6 (IL-6)", "code_information": [{"code": "83529", "type": "CPT"}], "standard_charges": [{"minimum": 11.89, "maximum": 65.51, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11133.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11133.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3722.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11368.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11368.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3804.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASCN PIP FNGR RPLCMNT", "code_information": [{"code": "L8659", "type": "HCPCS"}, {"code": "8130166", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 8422.02, "maximum": 8422.02, "gross_charge": 7583.0, "discounted_cash": 5687.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8422.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCORBIC ACID", "code_information": [{"code": "82180", "type": "CPT"}, {"code": "7252180", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.51, "gross_charge": 290.0, "discounted_cash": 217.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCORBIC ACID 1GM/2ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318315", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASCORBIC ACID 250MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301057", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCORBIC ACID 250MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301057", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCORBIC ACID 500MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301061", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCORBIC ACID 500MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301061", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASENAPINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301081", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASENAPINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301081", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASENAPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301080", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASENAPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301080", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 114.0, "discounted_cash": 85.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9287.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 853.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 563.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 626.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9287.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, 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[{"code": "4900608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ INTERM JT WO/US", "code_information": [{"code": "4910608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ INTERM JT WO/US", "code_information": [{"code": "5050608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ RENL CYST/PELVIS", "code_information": [{"code": "5057585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3052.0, "discounted_cash": 2289.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASP/INJ RENL 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"UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPARAGINASE, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.17, "maximum": 202.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 202.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AB", "code_information": [{"code": "86606", "type": "CPT"}, {"code": "7256606", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.08, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AB/2", "code_information": [{"code": "86606", "type": "CPT"}, {"code": "7256607", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.08, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AB/3", "code_information": [{"code": "86606", "type": "CPT"}, {"code": "7256931", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.08, "gross_charge": 277.0, "discounted_cash": 207.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS IA", "code_information": [{"code": "87305", "type": "CPT"}, {"code": "7257306", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 571.0, "discounted_cash": 428.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIR BLADDR W/INS CATH", "code_information": [{"code": "4917460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5886.0, "discounted_cash": 4414.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR BLADDR W/INS CATH", "code_information": [{"code": "5050607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7186.0, "discounted_cash": 5389.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR BREAST CYST", "code_information": [{"code": "5066650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR BREAST CYST ADD", "code_information": [{"code": "5066652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1995.0, "discounted_cash": 1496.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ INTMD JT W/US", "code_information": [{"code": "5060607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5727.0, "discounted_cash": 4295.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJ JT WO/US", "code_information": [{"code": "4900610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4173.0, "discounted_cash": 3129.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJ JT WO/US", "code_information": [{"code": "4910610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2782.0, "discounted_cash": 2086.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJ JT WO/US", "code_information": [{"code": "5050610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2782.0, "discounted_cash": 2086.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ MAJOR JT W/US", "code_information": [{"code": "5060611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5727.0, "discounted_cash": 4295.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ SM JNT WO/US", "code_information": [{"code": "4900600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ SM JNT WO/US", "code_information": [{"code": "4910600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5118.0, "discounted_cash": 3838.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ SMALL JT W/US", "code_information": [{"code": "5060604", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5727.0, "discounted_cash": 4295.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/ IMAGING", "code_information": [{"code": "32555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3865.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 391.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W/O IMAGING", "code_information": [{"code": "32554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3626.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 318.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE/INJ GANGLION CYST", "code_information": [{"code": "20612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 370.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 124.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY 17- KETOSTEROIDS", "code_information": [{"code": "83586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.87, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ACID PHOSPHATASE", "code_information": [{"code": "84060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY ANTI-MULLERIAN HORM", "code_information": [{"code": "82166", "type": "CPT"}], "standard_charges": [{"minimum": 26.31, "maximum": 146.49, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CATECHOLAMINES", "code_information": [{"code": "82383", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 48.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 56.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY C-D TRANSFER MEASURE", "code_information": [{"code": "82373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charges": [{"minimum": 1.0, "maximum": 92.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 54.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 25.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY TOXIN OR ANTITOXIN", "code_information": [{"code": "87230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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[{"minimum": 1.0, "maximum": 353.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89280", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89281", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSISTIVE TECHNOLOGY ASSESS", "code_information": [{"code": "97755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 140.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSMT & CARE PLN PT COG IMP", "code_information": [{"code": "99483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 703.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 703.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301145", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301146", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301146", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301147", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301147", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301148", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATORVASTATIN 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301148", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOVAQ/PROGUAN250/100 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301151", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOVAQ/PROGUAN250/100 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301151", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOVAQUONE 750/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314293", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 329.0, "discounted_cash": 246.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATOVAQUONE 750/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314293", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 329.0, "discounted_cash": 246.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATRIAL APPENDGE OCCLUSN", "code_information": [{"code": "4619379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE 1% 3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330331", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE 1% 3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330331", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE 1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330282", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE 1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330282", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7635", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7636", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE PER 0.01MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "5318387", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE PER 0.01MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "5318387", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE PER 0.01MGPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "5318388", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE PER 0.01MGPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "5318388", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2539.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 847.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2934.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3379.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1112.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5032.44, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5032.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1671.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9871.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3278.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3388.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1127.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATTENDANCE AT DELIVERY", "code_information": [{"code": "99464", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 263.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 397.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 397.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "209T", "type": "CPT"}], "standard_charges": [{"minimum": 153.05, "maximum": 153.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR ONLY", "code_information": [{"code": "208T", "type": "CPT"}], "standard_charges": [{"minimum": 123.92, "maximum": 123.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST 15-30 MIN", "code_information": [{"code": "99408", "type": "CPT"}], "standard_charges": [{"minimum": 115.23, "maximum": 115.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST OVER 30 MIN", "code_information": [{"code": "99409", "type": "CPT"}], "standard_charges": [{"minimum": 230.5, "maximum": 230.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 323.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUGMENT ORTHO DEVELOPMENT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8374.0, "discounted_cash": 6280.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2726.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 284.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1247.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 284.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2440.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2003.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3079.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2003.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2826.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3373.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4739.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3373.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2693.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1965.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AURICULAR PROSTHESIS", "code_information": [{"code": "D5914", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 10411.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10411.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AURICULAR REPLACEMENT", "code_information": [{"code": "D5927", "type": "HCPCS"}], "standard_charges": [{"minimum": 5205.66, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5205.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUROTHIOGLUCOSE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2910", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.51, "maximum": 111.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3859.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1297.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"minimum": 8.47, "maximum": 31.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ CPTR ALYS", "code_information": [{"code": "625T", "type": "CPT"}], "standard_charges": [{"minimum": 132.38, "maximum": 132.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ DATA PREP", "code_information": [{"code": "624T", "type": "CPT"}], "standard_charges": [{"minimum": 223.52, "maximum": 223.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 223.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUAN C PLAQ I&R", "code_information": [{"code": "626T", "type": "CPT"}], "standard_charges": [{"minimum": 261.22, "maximum": 261.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"minimum": 615.91, "maximum": 615.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 615.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTO TISSUE GRAFT 1ST TOOTH", "code_information": [{"code": "D4273", "type": "HCPCS"}], "standard_charges": [{"minimum": 1350.35, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1350.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6002.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2016.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3188.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 837.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 553.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 614.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3188.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 756.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA 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DIAB ULCER", "code_information": [{"code": "G0460", "type": "HCPCS"}], "standard_charges": [{"minimum": 2777.88, "maximum": 2777.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2777.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BLOOD OP SALVAGE", "code_information": [{"code": "86891", "type": "CPT"}], "standard_charges": [{"minimum": 69.57, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 69.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 77.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_dollar": 173.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) GROSS", "code_information": [{"code": "88016", "type": "CPT"}], "standard_charges": [{"minimum": 165.48, "maximum": 980.87, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 165.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 183.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 980.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 242.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 32023.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2862.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 955.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 38901.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2683.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 895.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 62223.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2588.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 34526.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2445.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 815.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 50378.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2340.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 780.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2576.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV TUNNELER/SCNLN SHEATH", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8201079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AXLE DISTAL FEMORAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8252.0, "discounted_cash": 6189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AXOLOTL GRAF DUALGRAF SQ CM", "code_information": [{"code": "Q4210", "type": "HCPCS"}], "standard_charges": [{"minimum": 3216.46, "maximum": 3216.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3216.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZACITIDINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9025", "type": "HCPCS"}, {"code": "5318413", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.34, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZACITIDINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9025", "type": "HCPCS"}, {"code": "5318413", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.34, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7500", "type": "HCPCS"}, {"code": "5301215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 17.29, "maximum": 17.29, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7500", "type": "HCPCS"}, {"code": "5301215", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 17.29, "maximum": 17.29, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7501", "type": "HCPCS"}, {"code": "5318415", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 824.22, "maximum": 824.22, "gross_charge": 1488.0, "discounted_cash": 1116.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7501", "type": "HCPCS"}, {"code": "5318415", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 824.22, "maximum": 824.22, "gross_charge": 1488.0, "discounted_cash": 1116.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 100/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 100/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314301", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 570.0, "discounted_cash": 427.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314301", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 570.0, "discounted_cash": 427.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314263", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314263", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314305", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYC 200/5 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314305", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 1GM PWLQ", "code_information": [{"code": "Q0144", "type": "HCPCS"}, {"code": "5314303", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 47.22, "maximum": 47.22, "gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 1GM PWLQ", "code_information": [{"code": "Q0144", "type": "HCPCS"}, {"code": "5314303", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 47.22, "maximum": 47.22, "gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301225", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 131.0, "discounted_cash": 98.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301225", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 131.0, "discounted_cash": 98.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301220", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301220", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301221", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301221", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 500MG/12.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314321", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 500MG/12.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314321", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301223", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 318.0, "discounted_cash": 238.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301223", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 318.0, "discounted_cash": 238.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "5318414", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.86, "maximum": 9.86, "gross_charge": 500.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "5318414", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.86, "maximum": 9.86, "gross_charge": 500.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZTREONAM PED PER1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318425", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 422.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZTREONAM PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0457", "type": "HCPCS"}, {"code": "5318430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.63, "maximum": 9.63, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZTREONAM PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0457", "type": "HCPCS"}, {"code": "5318430", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.63, "maximum": 9.63, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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[{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48597.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41134.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39737.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38196.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63919.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80713.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "96", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27992.06, "maximum": 59151.37, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30195.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30145.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 29121.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 27992.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46843.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 59151.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACTERICIDAL LEVEL SERUM", "code_information": [{"code": "87197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERIUM AB NES", "code_information": [{"code": "86609", "type": "CPT"}, {"code": "7256601", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.85, "gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLN VALVULPLSTY MITRL", "code_information": [{"code": "92987", "type": "CPT"}, {"code": "4612987", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29223.75, "gross_charge": 38965.0, "discounted_cash": 29223.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 25327.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 15586.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4857.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 29223.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1623.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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"FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 641.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 676.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 971.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 676.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIALYSIS SEG", "code_information": [{"code": "36907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 22609.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 456.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 680.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 456.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALOON DILATE URETER", "code_information": [{"code": "4910706", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11347.0, "discounted_cash": 8510.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BALSALAZIDE 750MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301370", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALSALAZIDE 750MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301370", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALSAM P/CAST OIL 60GMOI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334313", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALSAM P/CAST OIL 60GMOI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334313", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUS HOME", "code_information": [{"code": "M0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 2796.39, "maximum": 2796.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2796.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUSION", "code_information": [{"code": "M0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1677.83, "maximum": 1677.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAMLANIVIMAB AND ETESEVIMA", "code_information": [{"code": "Q0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAND ANNULOPLASTY", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8141021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16727.0, "discounted_cash": 12545.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR LOCKING TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1209.0, "discounted_cash": 906.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR ORTHO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2524.0, "discounted_cash": 1893.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BARBITURATE", "code_information": [{"code": "80345", "type": "CPT"}, {"code": "7250345", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 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1.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEVACIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9035", "type": "HCPCS"}], "standard_charges": [{"minimum": 280.96, "maximum": 280.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING 1ST 15 MIN", "code_information": [{"code": "90912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 154.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING EA ADDL 15 MIN", "code_information": [{"code": "90913", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BG FECAL COLLECTION", "code_information": [{"code": "A4330", "type": "HCPCS"}, {"code": "8031126", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 37.1, "maximum": 37.1, "gross_charge": 1089.0, "discounted_cash": 816.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID ASSMT BY PHYS/QHP", "code_information": [{"code": "97151", "type": "CPT"}], "standard_charges": [{"minimum": 151.72, "maximum": 151.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT BY 1 TECH", "code_information": [{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 117.58, "maximum": 117.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT EA 15 MIN", "code_information": [{"code": "362T", "type": "CPT"}], "standard_charges": [{"minimum": 458.04, "maximum": 458.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 458.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIA WHOLE BODY", "code_information": [{"code": "358T", "type": "CPT"}], "standard_charges": [{"minimum": 33.91, "maximum": 33.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICALUTAMIDE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301590", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICALUTAMIDE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301590", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICTEG/EMTRIC/TENOF50/200/25TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301581", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BICTEG/EMTRIC/TENOF50/200/25TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301581", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [{"code": "461", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59941.12, "maximum": 126664.48, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 73139.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 64552.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 62360.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 59941.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 100308.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 126664.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [{"code": "462", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28868.98, "maximum": 61004.44, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 50853.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31090.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30034.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 28868.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48310.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61004.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.61, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 30.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}, {"code": "7252239", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.94, "gross_charge": 1796.0, "discounted_cash": 1347.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 33.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 585.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6279.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2099.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 993.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 994.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1600.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 537.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1185.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 398.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1342.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 451.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [{"code": "409", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23630.24, "maximum": 49934.2, "estimated_discounted_cash": 197132.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32369.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25448.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24583.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23630.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39544.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49934.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "408", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38697.46, "maximum": 81773.47, "estimated_discounted_cash": 340570.39, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 56771.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41674.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40259.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38697.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64758.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81773.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "410", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17231.31, "maximum": 36412.31, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23610.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18557.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17926.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17231.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28835.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36412.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "4102253", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 265.0, "discounted_cash": 198.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "4172253", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee 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"standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4122250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4152250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4172250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "7252247", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL/2", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "4102250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 274.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTL TRNSCTNS", "code_information": [{"code": "88720", "type": "CPT"}, {"code": "4108400", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "gross_charge": 318.0, "discounted_cash": 238.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.19, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5645.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1891.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIMATOPROST.01% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330416", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1210.0, "discounted_cash": 907.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIMATOPROST.01% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330416", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1210.0, "discounted_cash": 907.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIO MTRLS TO AID SOFT/OS REG", "code_information": [{"code": "D4265", "type": "HCPCS"}], "standard_charges": [{"minimum": 539.67, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIO-CONNEKT PER SQUARE CM", "code_information": [{"code": "Q4161", "type": "HCPCS"}], "standard_charges": [{"minimum": 524.55, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 524.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIODFENCE DRYFLEX, 1CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}], "standard_charges": [{"minimum": 910.47, "maximum": 910.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 910.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 49.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 97.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOLOGICAL MATERIALS", "code_information": [{"code": "D3431", "type": "HCPCS"}], "standard_charges": [{"minimum": 1320.19, "maximum": 1320.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1320.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26689.7, "maximum": 56399.29, "estimated_discounted_cash": 148947.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32694.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28743.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27766.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26689.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44663.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56399.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37492.77, "maximum": 79227.8, "estimated_discounted_cash": 120071.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46093.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 40377.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39005.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37492.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62742.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 79227.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20174.64, "maximum": 42632.01, "estimated_discounted_cash": 67951.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25221.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21726.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20988.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20174.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33761.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42632.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ABDOMINAL MASS", "code_information": [{"code": "49180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4185.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 598.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1562.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 211.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 211.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY BONE DEEP", "code_information": [{"code": "4917503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4927.0, "discounted_cash": 3695.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE DEEP", "code_information": [{"code": "5057503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4927.0, "discounted_cash": 3695.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "5057504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4927.0, "discounted_cash": 3695.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY BONE SUPERFICIAL", "code_information": [{"code": "5060226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4072.0, "discounted_cash": 3054.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYELID & LID MARGIN", "code_information": [{"code": "67810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 245.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 218.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 69004.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 430.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1216.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 308.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1366.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 465.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY HAND JOINT LINING", "code_information": [{"code": "26100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1270.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 427.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY KNEE JOINT LINING", "code_information": [{"code": "27330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 529.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 12312.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 594.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 306.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1533.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 709.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY MUSCLE PERQ NEEDLE", "code_information": [{"code": "20206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6343.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 206.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 257.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 147.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BOWEL", "code_information": [{"code": "44100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 127.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF BREAST OPEN", "code_information": [{"code": "19101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 814.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 386.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX", "code_information": [{"code": "57500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX W/SCOPE", "code_information": [{"code": "57455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 394.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA", "code_information": [{"code": "65410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 370.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS", "code_information": [{"code": "54800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 454.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR", "code_information": [{"code": "69100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 114.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EXTERNAL EAR CANAL", "code_information": [{"code": "69105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EYELID LINING", "code_information": [{"code": "68100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 345.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 213.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 335.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1031.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 504.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 946.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 137.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 470.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 137.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1512.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 480.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2144.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 721.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP", "code_information": [{"code": "40490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF MOUTH LESION", "code_information": [{"code": "40808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NECK/CHEST", "code_information": [{"code": "21550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 571.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE", "code_information": [{"code": "64795", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 705.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE HARD", "code_information": [{"code": "D7285", "type": "HCPCS"}], "standard_charges": [{"minimum": 578.43, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE SOFT", "code_information": [{"code": "D7286", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.3, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY(S)", "code_information": [{"code": "58900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1607.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 533.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3240.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1080.33, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 442.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 245.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 778.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 336.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 16473.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 470.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 964.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 323.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF RECTUM", "code_information": [{"code": "45100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1112.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 373.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1511.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 509.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 192.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 114.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 834.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 371.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1880.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 632.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2600.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 871.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3036.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1028.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR GLAND", "code_information": [{"code": "68510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1035.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 537.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 928.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 310.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 765.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 257.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THROAT", "code_information": [{"code": "42800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 431.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 275.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 865.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 454.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 522.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF URETHRA", "code_information": [{"code": "53200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UTERUS LINING", "code_information": [{"code": "58100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 213.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 116.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 45.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF WRIST JOINT", "code_information": [{"code": "25100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1306.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 439.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ROOF OF MOUTH", "code_information": [{"code": "42100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 586.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 273.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1365.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 210.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 701.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 210.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 106.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 308.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 106.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1394.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 604.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY TESTIS", "code_information": [{"code": "5064500", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5060.0, "discounted_cash": 3795.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 642.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TISSUES", "code_information": [{"code": "27324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1517.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN LMBR/CRV", "code_information": [{"code": "20251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1527.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY VRT BDY OPEN THORACIC", "code_information": [{"code": "20250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1427.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 480.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "5060018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19793.0, "discounted_cash": 14844.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 3898.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 930.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 407.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1524.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1708.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 574.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 17944.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1611.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 540.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2066.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOVANCE 1 SQUARE CM", "code_information": [{"code": "Q4154", "type": "HCPCS"}], "standard_charges": [{"minimum": 563.12, "maximum": 563.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 563.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOVANCE TRI OR 3L, SQ CM", "code_information": [{"code": "Q4283", "type": "HCPCS"}], "standard_charges": [{"minimum": 5803.29, "maximum": 5803.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5803.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIPAP INITIAL", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5501857", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 236.38, "gross_charge": 2000.0, "discounted_cash": 1500.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 236.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIPAP MANAGEMENT DLY", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "5504662", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 236.38, "gross_charge": 2000.0, "discounted_cash": 1500.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 236.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIS XTRACELL FLUID ANALYSIS", "code_information": [{"code": "93702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 444.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 444.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISACODYL 10MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338162", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISACODYL 10MG SU", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338162", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISACODYL 5MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301602", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISACODYL 5MG EC TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301602", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISMUTH SUBSALI 15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISMUTH SUBSALI 15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316006", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISMUTH SUBSLCY262MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301616", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISMUTH SUBSLCY262MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301616", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BISOPRL/HCTZ 2.5/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301607", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPRL/HCTZ 2.5/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301607", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROL/HCTZ 10/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301609", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROL/HCTZ 10/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301609", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROL/HCTZ 5/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301608", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROL/HCTZ 5/6.25 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301608", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301605", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BISOPROLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301605", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BITEWINGS - THREE IMAGES", "code_information": [{"code": "D0273", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.86, "maximum": 45.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BITEWINGS FOUR IMAGES", "code_information": [{"code": "D0274", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.78, "maximum": 56.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7628", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.83, "maximum": 0.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP UNT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7629", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.68, "maximum": 0.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIVALIRUDIN PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0583", "type": "HCPCS"}, {"code": "5318617", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.81, "maximum": 0.81, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIVALIRUDIN PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0583", "type": "HCPCS"}, {"code": "5318617", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.81, "maximum": 0.81, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL DONOR SEARCH MANAGEMENT", "code_information": [{"code": "38204", "type": "CPT"}], "standard_charges": [{"minimum": 365.11, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 365.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS SCALP VEIN", "code_information": [{"code": "36405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/O DIFF WBC COUNT", "code_information": [{"code": "85008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLADDER CALCULI IRRIG SOL", "code_information": [{"code": "Q2004", "type": "HCPCS"}], "standard_charges": [{"minimum": 304.69, "maximum": 304.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLASTOMYCES ANTIBODY", "code_information": [{"code": "86612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD CUTTR TURBOHAWK SUPR", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "8172283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42676.0, "discounted_cash": 32007.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLD DRV T LYMPHCYT CAR-T CLL", "code_information": [{"code": "537T", "type": "CPT"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ NEWBORN", "code_information": [{"code": "36450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 616.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD PLASMA FROZEN", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "4500018", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"minimum": 303.29, "maximum": 303.29, "gross_charge": 642.0, "discounted_cash": 481.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD SMR EXAM W/DIFF", "code_information": [{"code": "85007", "type": "CPT"}, {"code": "4105007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 14.41, "gross_charge": 318.0, "discounted_cash": 238.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD SMR EXAM W/DIFF", "code_information": [{"code": "85007", "type": "CPT"}, {"code": "4125007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 14.41, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLD SMR EXAM W/DIFF", "code_information": [{"code": "85007", "type": "CPT"}, {"code": "4155007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 14.41, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee 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"code_information": [{"code": "85002", "type": "CPT"}, {"code": "4105003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.28, "gross_charge": 589.0, "discounted_cash": 441.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME", "code_information": [{"code": "85002", "type": "CPT"}, {"code": "4125003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.28, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME", "code_information": [{"code": "85002", "type": "CPT"}, {"code": "4155003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.28, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME", "code_information": [{"code": "85002", "type": "CPT"}, {"code": "4175003", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.28, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEOMYCIN PER 15U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9040", "type": "HCPCS"}, {"code": "5318621", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 79.74, "maximum": 79.74, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEOMYCIN PER 15U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9040", "type": "HCPCS"}, {"code": "5318621", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 79.74, "maximum": 79.74, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLIND COR SINUS REDUCER IMPL", "code_information": [{"code": "C9783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND MYOCAR TRPL BON MARROW", "code_information": [{"code": "C9782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND/NONBLIND TRANS ATRIAL", "code_information": [{"code": "C9792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLINDED CONV. 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"setting": "both", "billing_class": "facility"}]}, {"description": "BN PASTE 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8031372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11876.0, "discounted_cash": 8907.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BN PASTE 3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8031374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10274.0, "discounted_cash": 7705.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BN PLUGS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 2306.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BN STRIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17424.0, "discounted_cash": 13068.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BODY FLUID CELL COUNT", "code_information": [{"code": "89050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY-WORN BILAT HEARING AID", "code_information": [{"code": "V5100", "type": "HCPCS"}], "standard_charges": [{"minimum": 4085.71, "maximum": 4085.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4085.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY-WORN BINAUR HEARING AID", "code_information": [{"code": "V5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 3571.07, "maximum": 3571.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3571.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY-WORN HEARING AID AIR", "code_information": [{"code": "V5030", "type": "HCPCS"}], "standard_charges": [{"minimum": 2483.62, "maximum": 2483.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2483.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY-WORN HEARING AID BONE", "code_information": [{"code": "V5040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1887.85, "maximum": 1887.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1887.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLT LOCKING 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7228.0, "discounted_cash": 5421.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT LOCKING 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2268.0, "discounted_cash": 1701.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4089.0, "discounted_cash": 3066.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE AGE STUDIES", "code_information": [{"code": "77072", "type": "CPT"}, {"code": "4906020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.97, "gross_charge": 966.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.46, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 59.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 66.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN DEEP", "code_information": [{"code": "20245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1244.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 415.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY OPEN SUPERFICIAL", "code_information": [{"code": "20240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15338.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 509.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 170.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL DEEP", "code_information": [{"code": "20225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 4810.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 465.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 261.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 448.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 261.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY TROCAR/NDL SUPFC", "code_information": [{"code": "20220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 13044.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee 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"MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 151.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 151.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING BODY MANDIBLE", "code_information": [{"code": "D7945", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 12568.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12568.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING RAMUS CLOSED", "code_information": [{"code": "D7941", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 15572.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15572.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING SEGMENTED", "code_information": [{"code": "D7944", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 12457.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12457.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14068.74, "maximum": 29729.34, "estimated_discounted_cash": 94707.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17755.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15151.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14636.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14068.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23543.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29729.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9009.08, "maximum": 19037.51, "estimated_discounted_cash": 62536.74, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10597.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9702.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9372.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9009.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15076.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19037.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI EACH ADDL", "code_information": [{"code": "D3429", "type": "HCPCS"}], "standard_charges": [{"minimum": 534.78, "maximum": 534.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 534.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI PER TOOTH", "code_information": [{"code": "D3428", "type": "HCPCS"}], "standard_charges": [{"minimum": 544.6, "maximum": 544.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT REPAIR PERIMPLANT", "code_information": [{"code": "D6103", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.61, "maximum": 631.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 631.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT TIME OF IMPLANT", "code_information": [{"code": "D6104", "type": "HCPCS"}], "standard_charges": [{"minimum": 849.44, "maximum": 849.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 849.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE HARVEST,AUTO GRAFT PROC", "code_information": [{"code": "D7295", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 3114.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3114.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAG 3 PHASE STUDY", "code_information": [{"code": "78315", "type": "CPT"}, {"code": "5208315", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1359.44, "gross_charge": 7020.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 569.53, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 512.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1223.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1359.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED", "code_information": [{"code": "78300", "type": "CPT"}, {"code": "5208300", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 668.73, "gross_charge": 5477.0, "discounted_cash": 4107.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 289.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 257.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 601.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 668.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 646.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 883.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 409.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 327.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 795.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 883.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 767.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}, {"code": "5208307", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 982.87, "gross_charge": 8945.0, "discounted_cash": 6708.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.99, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 362.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 884.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 982.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 834.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}, {"code": "4906040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 117.32, "gross_charge": 1330.0, "discounted_cash": 997.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 102.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 113.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIR BONE GRFG", "code_information": [{"code": "20939", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 731.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 682.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 990.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 463.11, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 357.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 891.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 990.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 228.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 646.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 255.19, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 246.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 581.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 646.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 859.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 371.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 320.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 773.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 859.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 514.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 148.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 49.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 55.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 78.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 106.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PUTTY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8031657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35909.0, "discounted_cash": 26931.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE REPLACEMENT GRAFT", "code_information": [{"code": "D7953", "type": "HCPCS"}], "standard_charges": [{"minimum": 2112.78, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2112.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT EACH ADD", "code_information": [{"code": "D4264", "type": "HCPCS"}], "standard_charges": [{"minimum": 636.5, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 636.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT FIRST SITE", "code_information": [{"code": "D4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 776.81, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 776.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR CT/MRI IMAG", "code_information": [{"code": "55T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 832.64, "estimated_discounted_cash": 20425.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR FLUOR IMAGE", "code_information": [{"code": "54T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 413.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 413.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}, {"code": "4906063", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 354.56, "gross_charge": 3483.0, "discounted_cash": 2612.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 163.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 319.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 354.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 267.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}, {"code": "4906065", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 297.66, "gross_charge": 2238.0, "discounted_cash": 1678.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 101.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 267.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 297.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}, {"code": "4906060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 222.27, "gross_charge": 1866.0, "discounted_cash": 1399.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 109.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 68.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 200.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 222.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10870.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3647.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10323.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10323.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3465.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10292.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3454.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9861.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9861.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3294.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOOT/SHOE SURGICAL", "code_information": [{"code": "L3260", "type": "HCPCS"}, {"code": "8131331", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"minimum": 44.8, "maximum": 44.8, "gross_charge": 826.0, "discounted_cash": 619.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA AB", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "7256924", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORDETELLA AB/2", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "7256928", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA ANTIBODY", "code_information": [{"code": "86619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 24.14, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORTEZOMIB PER .1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9041", "type": "HCPCS"}, {"code": "5318644", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 7.43, "maximum": 7.43, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BORTEZOMIB PER .1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9041", "type": "HCPCS"}, {"code": "5318644", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.43, "maximum": 7.43, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"minimum": 18.78, "maximum": 18.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN A PERUIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "5318651", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM TOXIN A PERUIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}, {"code": "5318651", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4762.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4762.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1597.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BPCI ADVANCED IN HOME VISIT", "code_information": [{"code": "G9987", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 57.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BPCI HOME VISIT", "code_information": [{"code": "G9187", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 57.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY RADIOELEMENTS", "code_information": [{"code": "Q3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 224.01, "maximum": 224.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 224.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1623.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1005.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 335.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1460.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1120.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1623.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 695.66, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 247.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1460.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1623.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 828.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 628.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 533.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 189.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 525.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 628.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF V600E VARIANT", "code_information": [{"code": "81210", "type": "CPT"}, {"code": "7251210", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 665.29, "gross_charge": 2976.0, "discounted_cash": 2232.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 255.52, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 296.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 105.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 116.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF V600E VARIANT", "code_information": [{"code": "81210", "type": "CPT"}, {"code": "7270012", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 665.29, "gross_charge": 2728.0, "discounted_cash": 2046.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 255.52, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 296.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 105.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 116.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15285.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15285.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5107.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16722.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16722.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5594.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12369.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12369.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4134.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5080.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5080.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1701.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN CANAL SHUNT PROCEDURE", "code_information": [{"code": "61070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 203.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4454.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4454.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1492.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAG VASC FLO ONLY", "code_information": [{"code": "78610", "type": "CPT"}, {"code": "5208610", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 766.08, "gross_charge": 4594.0, "discounted_cash": 3445.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 227.6, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 274.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 689.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 766.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 538.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 793.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 375.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 296.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 714.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 793.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 584.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 731.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 392.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 279.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 658.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 731.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 537.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 870.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 389.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 327.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 783.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 642.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.19, "methodology": "fee schedule"}, 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2250.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 757.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC", "code_information": [{"code": "584", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23233.02, "maximum": 49094.81, "estimated_discounted_cash": 340545.82, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25760.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25020.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24170.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23233.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38879.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49094.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "585", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20035.29, "maximum": 44241.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20035.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22547.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21781.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20936.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35036.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44241.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECONSTRUCTION", "code_information": [{"code": "19350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2459.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1016.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST REDUCTION", "code_information": [{"code": "19318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3980.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1339.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 116.89, "maximum": 485.42, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 436.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 485.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 406.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 233.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 67.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 689.11, "maximum": 689.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 689.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 501.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 244.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 152.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 501.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 358.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 52.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 58.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 41.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRENTUXIMAB VEDOTIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9042", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.72, "maximum": 874.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 874.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE BASE METAL CAST", "code_information": [{"code": "D6211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1176.17, "maximum": 1176.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1176.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE NOBLE METAL CAST", "code_information": [{"code": "D6212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1343.18, "maximum": 1343.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN BASE METAL", "code_information": [{"code": "D6241", "type": "HCPCS"}], "standard_charges": [{"minimum": 1511.4, "maximum": 1511.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1511.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1849.01, "maximum": 1849.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1849.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN NOBEL METAL", "code_information": [{"code": "D6242", "type": "HCPCS"}], "standard_charges": [{"minimum": 1679.58, "maximum": 1679.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1679.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN/CERAMIC", "code_information": [{"code": "D6245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1268.11, "maximum": 1268.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1268.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN BASE METAL", "code_information": [{"code": "D6251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1176.17, "maximum": 1176.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1176.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/HIGH NOBLE", "code_information": [{"code": "D6250", "type": "HCPCS"}], "standard_charges": [{"minimum": 1679.58, "maximum": 1679.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1679.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/NOBLE METAL", "code_information": [{"code": "D6252", "type": "HCPCS"}], "standard_charges": [{"minimum": 1511.4, "maximum": 1511.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1511.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF ALCOHOL MISUSE COUNSEL", "code_information": [{"code": "G0443", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHECK IN BY MD/QHP", "code_information": [{"code": "G2012", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.5, "maximum": 46.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRILLIANT BLUE PER1MG IJ", "code_information": [{"code": "Q9968", "type": "HCPCS"}, {"code": "5358235", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 68.46, "maximum": 68.46, "gross_charge": 927.0, "discounted_cash": 695.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRILLIANT BLUE PER1MG IJ", "code_information": [{"code": "Q9968", "type": "HCPCS"}, {"code": "5358235", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 68.46, "maximum": 68.46, "gross_charge": 927.0, "discounted_cash": 695.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIMONIDINE .2% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330437", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 460.0, "discounted_cash": 345.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIMONIDINE .2% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330437", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 460.0, "discounted_cash": 345.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRINZOLAMIDE 1% 10ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330444", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1036.0, "discounted_cash": 777.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRINZOLAMIDE 1% 10ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330444", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1036.0, "discounted_cash": 777.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PLM NRV UNI", "code_information": [{"code": "782T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 527.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 509.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 170.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BROMOCRIPTINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301680", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROMOCRIPTINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301680", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROMPHENIRAMINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0945", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.03, "maximum": 3.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 144.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 788.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1068.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1443.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1068.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 874.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1093.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1496.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1093.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 2022.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH NON-DIAG BEDSIDE", "code_information": [{"code": "5500674", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7885.0, "discounted_cash": 5913.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 679.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 717.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 673.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1335.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1335.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ EBUS", "code_information": [{"code": "C7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH/LAVAG W/ NAVIGATION", "code_information": [{"code": "C7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 734.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 245.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 708.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10540.43, "maximum": 22273.5, "estimated_discounted_cash": 80224.32, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12784.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11351.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10965.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10540.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17638.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22273.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7271.51, "maximum": 15365.78, "estimated_discounted_cash": 39646.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9520.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7830.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7564.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7271.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12168.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15365.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 774.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 808.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 709.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 879.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 294.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20935.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 908.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 302.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 559.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 418.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 628.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 355.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 705.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 615.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 923.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 615.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 884.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 294.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 629.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 207.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 445.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 207.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 224.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 668.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 280.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 538.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 280.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSPASM EVAL PRE/PS", "code_information": [{"code": "94060", "type": "CPT"}, {"code": "5501201", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 105.18, "gross_charge": 1657.0, "discounted_cash": 1242.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6425.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2160.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7859.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2640.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7303.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2453.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9848.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9848.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3307.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ LATSMS DRSI FLAP", "code_information": [{"code": "19361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5659.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5659.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1903.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRUCELLA AB", "code_information": [{"code": "86622", "type": "CPT"}, {"code": "7256622", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.87, "gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 17.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRUSH BIOPSY", "code_information": [{"code": "D7288", "type": "HCPCS"}], "standard_charges": [{"minimum": 278.37, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BSE TB JRNY CTDUNCTD PLY SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11359.0, "discounted_cash": 8519.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BSK RETRV", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8041071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2541.0, "discounted_cash": 1905.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4981.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1660.93, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BSS IRR 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332452", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BSS PLUS IRR 500ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332457", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 665.29, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 176.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUCCAL/LABIAL FRENECTOMY", "code_information": [{"code": "D7961", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUDE/FORMT160/4 1DOSE IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330466", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDE/FORMT160/4 1DOSE IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330466", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE .5MG/2ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330448", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE .5MG/2ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330448", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE 3MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301725", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE 3MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301725", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7627", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7633", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.64, "maximum": 28.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7626", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.82, "maximum": 3.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUMETANIDE 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301738", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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{"description": "BUPROPION 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301746", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301748", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301748", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 150MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 150MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301749", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 150MG XR24 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301753", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 150MG XR24 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301753", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 300MG XR24 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301744", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 300MG XR24 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301744", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301745", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301745", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPROPION HCL SR 60 TABLETS", "code_information": [{"code": "S0106", "type": "HCPCS"}], "standard_charges": [{"minimum": 295.47, "maximum": 295.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE COVER II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8172867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1693.0, "discounted_cash": 1269.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2758.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 925.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUSHING DISTAL FEMORAL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8131342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4234.0, "discounted_cash": 3175.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSPIRONE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301761", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSPIRONE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301761", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSPIRONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSPIRONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSULFAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0594", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.36, "maximum": 5.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUT ATT SYS W/BUTTON TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3604.0, "discounted_cash": 2703.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTORPHANOL PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0595", "type": "HCPCS"}, {"code": "5318752", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 10.61, "maximum": 10.61, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0595", "type": "HCPCS"}, {"code": "5318752", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.61, "maximum": 10.61, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL TARTRATE, NASAL", "code_information": [{"code": "S0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 207.06, "maximum": 207.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 207.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3242.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1086.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3683.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1236.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTON ARTHRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8172896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 2285.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON CBL HEX LCK PLT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1627.0, "discounted_cash": 1220.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON PECTORALIS REPAIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17039.0, "discounted_cash": 12779.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTRP ABS RND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1900.0, "discounted_cash": 1425.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ABD/RETROPER PERC NDL", "code_information": [{"code": "5057502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX ABD/RETROPER PERC NDL", "code_information": [{"code": "5067530", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 643.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 606.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 890.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 606.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 585.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 350.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 589.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 350.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION US IMAG", "code_information": [{"code": "19083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 553.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 358.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 358.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 519.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 519.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 293.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 314.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 447.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 314.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 276.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 312.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 439.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 312.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 248.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BRST 1ST LESION US", "code_information": [{"code": "5069183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7676.0, "discounted_cash": 5757.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BRST ADD LESION US", "code_information": [{"code": "5069184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3184.0, "discounted_cash": 2388.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX FORCEPS", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8081021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "4918215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4758.0, "discounted_cash": 3568.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "5058215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4758.0, "discounted_cash": 3568.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LIVER PERC NDL", "code_information": [{"code": "5067520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4758.0, "discounted_cash": 3568.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LUNG/MEDIAST PERC NDL", "code_information": [{"code": "4917510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5326.0, "discounted_cash": 3994.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LUNG/MEDIAST PERC NDL", "code_information": [{"code": "5057510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11116.0, "discounted_cash": 8337.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX LUNG/MEDIAST PERC NDL", "code_information": [{"code": "5067510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7853.0, "discounted_cash": 5889.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NDL", "code_information": [{"code": "5057511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 2928.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NDL", "code_information": [{"code": "5067515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 2928.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 163.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 373.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 163.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX PANCREAS PERC NDL", "code_information": [{"code": "5057512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX PLEURA PERC NDL", "code_information": [{"code": "5057505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX PLEURA PERC NDL", "code_information": [{"code": "5067505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3609.0, "discounted_cash": 2706.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BX RENAL PERC NDL", "code_information": [{"code": "5057514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4468.0, "discounted_cash": 3351.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX RENAL PERC NDL", "code_information": [{"code": "5067535", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4468.0, "discounted_cash": 3351.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SALIVARY GLAND NDL", "code_information": [{"code": "5062400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3488.0, "discounted_cash": 2616.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX SPINAL CORD NDL PERC", "code_information": [{"code": "4912269", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3223.0, "discounted_cash": 2417.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BX THYROID PERC NDL", "code_information": [{"code": "5067545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3904.0, "discounted_cash": 2928.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 486.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9508.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3182.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9357.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3146.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRLMB", "code_information": [{"code": "63287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9966.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3335.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN CRVL", "code_information": [{"code": "63280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7725.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2579.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN LMBR", "code_information": [{"code": "63282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7224.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2422.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN SCRL", "code_information": [{"code": "63283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6950.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2327.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN THRC", "code_information": [{"code": "63281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7662.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2560.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6564.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2196.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN LMBR", "code_information": [{"code": "63277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5698.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1911.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN SCRL", "code_information": [{"code": "63278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5831.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1953.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN THRC", "code_information": [{"code": "63276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6523.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2183.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL/IDRL LSN ANY LVL", "code_information": [{"code": "63290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10133.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3391.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT PATENCY/PATCH", "code_information": [{"code": "35685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 232.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT/AV FIST PATENCY", "code_information": [{"code": "35686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 188.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Balloon Catheter Enlargement Of Opening Between Two Upper Heart Chambers", "code_information": [{"code": "92992", "type": "CPT"}], "standard_charges": [{"minimum": 7716.25, "maximum": 7716.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7716.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bamlanivimab-xxxx", "code_information": [{"code": "Q0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bamlanivimab-xxxx infusion", "code_information": [{"code": "M0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 1122.92, "maximum": 1122.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1122.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment Services, 090x Extension: Individual Therapy", "code_information": [{"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 410.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment Services, Intensive Outpatient Chemical Dependency", "code_information": [{"code": "906", "type": "RC"}], "standard_charges": [{"minimum": 410.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment Services, Intensive Outpatient Psychiatric", "code_information": [{"code": "905", "type": "RC"}], "standard_charges": [{"minimum": 410.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment, Services 090x Extension: Family Therapy", "code_information": [{"code": "916", "type": "RC"}], "standard_charges": [{"minimum": 410.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Behavioral Health Treatment, Services 090x Extension: Group Therapy", "code_information": [{"code": "915", "type": "RC"}], "standard_charges": [{"minimum": 410.0, "maximum": 410.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA BEHAVIORAL HEALTH COMMERCIAL/HIX", "standard_charge_dollar": 410.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-40 (Abeta 40)", "code_information": [{"code": "82233", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Beta-amyloid; 1-42 (Abeta 42)", "code_information": [{"code": "82234", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Biomechanical Mapping Accessed Through The Vagina", "code_information": [{"code": "487T", "type": "CPT"}], "standard_charges": [{"minimum": 421.59, "maximum": 421.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 421.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bone marrow aspirate &biopsy", "code_information": [{"code": "G0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Breast Enlargement Without A Prosthesis", "code_information": [{"code": "19324", "type": "CPT"}], "standard_charges": [{"minimum": 2044.43, "maximum": 3392.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2044.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation", "code_information": [{"code": "98016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.98, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bronchoscopy, rigid or flexible, non-thermal transbronchial ablation of lesion(s) by pulsed electric field (PEF) energy, including fluoroscopic and/or ultrasound guidance, when performed, with computed tomography acquisition(s) and 3D rendering, computer-", "code_information": [{"code": "C8005", "type": "HCPCS"}], "standard_charges": [{"minimum": 5390.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Bumetanide 0.5 mg", "code_information": [{"code": "S0171", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.72, "maximum": 3.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C DIFF TOX AG DETCJ IA STOOL", "code_information": [{"code": "107U", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C DIFF TOXIN AMP PROBE", "code_information": [{"code": "87493", "type": "CPT"}, {"code": "4108751", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 141.37, "gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 57.95, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C DIFF TOXIN AMP PROBE", "code_information": [{"code": "87493", "type": "CPT"}, {"code": "4127493", "type": "CDM"}, {"code": "300", 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"plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C FUNGI SKIN HAIR NAIL", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "4107101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.24, "gross_charge": 771.0, "discounted_cash": 578.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C FUNGI SKIN HAIR NAIL", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "4127101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.24, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C FUNGI SKIN HAIR NAIL", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "4157101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.24, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C FUNGI SKIN HAIR NAIL", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "4177101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.24, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED LWR LIMBS", "code_information": [{"code": "95929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 603.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 603.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPPR LIMBS", "code_information": [{"code": "95928", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 593.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 593.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPR&LWR LIMBS", "code_information": [{"code": "95939", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1605.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1605.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, BERINERT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0597", "type": "HCPCS"}], "standard_charges": [{"minimum": 244.1, "maximum": 244.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, CINRYZE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0598", "type": "HCPCS"}], "standard_charges": [{"minimum": 237.27, "maximum": 237.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 237.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LAMINOPLASTY W/GRAFT/PLATE", "code_information": [{"code": "63051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8853.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6159.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2063.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG CORNEOSCLRL LENS", "code_information": [{"code": "92313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 155.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 155.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA 1", "code_information": [{"code": "92315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA OU", "code_information": [{"code": "92316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 121.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH CORNEOSCLRL", "code_information": [{"code": "92317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH OU", "code_information": [{"code": "92314", "type": "CPT"}], "standard_charges": [{"minimum": 55.79, "maximum": 316.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 316.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-PEPTIDE", "code_information": [{"code": "84681", "type": "CPT"}, {"code": "7253976", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.93, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "4106021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 439.0, "discounted_cash": 329.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "4126021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "4156021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "4176021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/R EXER W/ ECG", "code_information": [{"code": "93798", "type": "CPT"}, {"code": "6010152", "type": "CDM"}, {"code": "943", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.01, "gross_charge": 839.0, "discounted_cash": 629.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C/R EXER W/O ECG", "code_information": [{"code": "93797", "type": "CPT"}, {"code": "6010153", "type": "CDM"}, {"code": "943", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA CARB VITD 250/125TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301833", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CA CARB VITD 250/125TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301833", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CA CARB VITD 500/200TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301834", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CA CARB VITD 500/200TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301834", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CA CARB1.25GM/5ML 5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314450", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CA CARB1.25GM/5ML 5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314450", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CA GLUC 1GM NS 50ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318824", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA GLUC 2GM NS 100ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318827", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA GLUC(WG CRITICAL) PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0613", "type": "HCPCS"}, {"code": "5318821", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.52, "discounted_cash": 0.39, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA GLUC(WG CRITICAL) PER10MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0613", "type": "HCPCS"}, {"code": "5318821", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.52, "discounted_cash": 0.39, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA GLUCONATE NOS PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0612", "type": "HCPCS"}, {"code": "5318819", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "gross_charge": 0.57, "discounted_cash": 0.43, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA GLUCONATE NOS PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0612", "type": "HCPCS"}, {"code": "5318819", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "gross_charge": 0.57, "discounted_cash": 0.43, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;FLEXI SIGMOIDSCOPE", "code_information": [{"code": "G0104", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6374.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 224.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CA SCREEN;PELVIC/BREAST EXAM", "code_information": [{"code": "G0101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 143.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CA TX E-STIM ELECTR/TRANSDUC", "code_information": [{"code": "A4555", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.24, "maximum": 87.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABAZITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 798.25, "maximum": 798.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 798.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301780", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE, ORAL 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8515", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.71, "maximum": 9.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2908.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9355.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3129.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6654.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2226.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8682.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2905.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7813.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2615.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2298.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 768.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 661.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 220.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1917.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1449.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 485.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9230.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9230.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3089.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8775.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8775.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2934.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6871.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2298.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9553.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9553.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3197.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8593.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8593.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2872.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7544.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2524.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CABLE DALL MILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8173000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3374.0, "discounted_cash": 2530.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CACL PER 2MG PFS IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0618", "type": "HCPCS"}, {"code": "5318804", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CACL PER 2MG PFS IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0618", "type": "HCPCS"}, {"code": "5318804", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CACNA1A FULL GENE ANALYSIS", "code_information": [{"code": "231U", "type": "CPT"}], "standard_charges": [{"minimum": 582.26, "maximum": 3209.9, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 582.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 647.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3209.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN DETC ABNOR ALLEL", "code_information": [{"code": "81184", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN KNOWN FAMIL VRNT", "code_information": [{"code": "81186", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 167.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 186.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A GENE FULL GENE SEQ", "code_information": [{"code": "81185", "type": "CPT"}], "standard_charges": [{"minimum": 761.64, "maximum": 3209.9, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 766.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 851.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3209.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD BREAST MRI", "code_information": [{"code": "C8937", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD CXR REMOTE", "code_information": [{"code": "175T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAD CXR WITH INTERP", "code_information": [{"code": "174T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 121.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CADEXOMER IODIN.9%40GMGL", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334648", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 536.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CADEXOMER IODIN.9%40GMGL", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334648", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 715.0, "discounted_cash": 536.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAFFEINE 200MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CAFFEINE 200MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301794", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CAFFEINE CIT 60MG/3ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314439", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 702.0, "discounted_cash": 526.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAFFEINE CIT 60MG/3ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314439", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 702.0, "discounted_cash": 526.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAFFEINE CIT PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0706", "type": "HCPCS"}, {"code": "5318762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.77, "maximum": 2.77, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAFFEINE CIT PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0706", "type": "HCPCS"}, {"code": "5318762", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.77, "maximum": 2.77, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAFFEINE/NA BENZ 500MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318767", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE EIT CONDUIT PLIF SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12908.0, "discounted_cash": 9681.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE 120ML LT", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334659", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE 120ML LT", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334659", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE 180ML LT", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334655", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE 180ML LT", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334655", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE/PRAMOX 180ML LT", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335280", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CALAMINE/PRAMOX 180ML LT", 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"standard_charge_dollar": 62.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", 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"standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAP BLD COLL", "code_information": [{"code": "36416", "type": "CPT"}, {"code": "4206417", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.83, "maximum": 244.0, "gross_charge": 244.0, "discounted_cash": 183.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING SCREW NCB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPECITABINE PER 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8522", "type": "HCPCS"}, {"code": "5301919", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.22, "discounted_cash": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPECITABINE PER 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8522", "type": "HCPCS"}, {"code": "5301919", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.22, "discounted_cash": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPECITABINE, ORAL, 150 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8520", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.93, "maximum": 0.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPECITABINE, ORAL, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8521", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.18, "maximum": 2.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSAICIN .025% 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334728", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSAICIN .025% 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334728", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSAICIN .075% 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334732", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSAICIN .075% 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5334732", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSAICIN 8% PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7336", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.41, "maximum": 12.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPTOPRIL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301922", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPTOPRIL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301922", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPTOPRIL 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301923", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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"HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPTOPRIL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5301927", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ABLT RAD ARR CNV LOC MAP", "code_information": [{"code": "746T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 783.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE 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{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 874.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3467.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 402.43, "maximum": 2218.53, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 402.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 447.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2218.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1137.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 751.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2218.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1137.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 751.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3387.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1131.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"minimum": 627.86, "maximum": 627.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 627.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBACHOL .01% 1.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330449", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 341.0, "discounted_cash": 255.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "4102372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.26, "gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "4122372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.26, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "4152372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.26, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBAMAZAPINE", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "4172372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.26, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "217", "type": "MS-DRG"}], "standard_charges": [{"minimum": 71361.73, "maximum": 150797.93, "estimated_discounted_cash": 670223.57, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 87107.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 92208.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 76852.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 74241.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 71361.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 119420.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 150797.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "216", "type": "MS-DRG"}], "standard_charges": [{"minimum": 87107.0, "maximum": 224358.74, "estimated_discounted_cash": 1174794.83, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 87107.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 138752.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 114341.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 110457.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 106172.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 177675.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 224358.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "218", "type": "MS-DRG"}], "standard_charges": [{"minimum": 71361.73, "maximum": 150797.93, "estimated_discounted_cash": 607871.57, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 87107.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 81139.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 76852.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 74241.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 71361.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 119420.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 150797.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "220", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57876.88, "maximum": 122302.44, "estimated_discounted_cash": 1124692.25, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 67886.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 75840.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 62329.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 60212.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57876.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96854.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122302.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "219", "type": "MS-DRG"}], "standard_charges": [{"minimum": 67886.0, "maximum": 176094.13, "estimated_discounted_cash": 1655250.81, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 67886.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 112278.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 89743.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 86695.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 83332.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 139453.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 176094.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "221", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54701.29, "maximum": 115591.95, "estimated_discounted_cash": 763079.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 67886.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 67522.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 58909.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 56908.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 54701.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91540.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 115591.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIO STRESS TRACE ONLY", "code_information": [{"code": "93017", "type": "CPT"}, {"code": "4603017", "type": "CDM"}, {"code": "482", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 136.55, "gross_charge": 4751.0, "discounted_cash": 3563.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIO STRESS TRACE ONLY", "code_information": [{"code": "93017", "type": "CPT"}, {"code": "5203017", "type": "CDM"}, {"code": "482", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 136.55, "gross_charge": 4751.0, "discounted_cash": 3563.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 354.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 354.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 666.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "7256381", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.53, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 49.4, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 57.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG/2", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "7256382", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.53, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 49.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 57.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12289.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4027.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2660.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2956.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12289.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2916.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOPLEG SOL 1053ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318926", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}, {"code": "5504622", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 320.43, "gross_charge": 1438.0, "discounted_cash": 1078.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 263.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELEC", "code_information": [{"code": "92960", "type": "CPT"}, {"code": "4611110", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 389.05, "gross_charge": 3202.0, "discounted_cash": 2401.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 389.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELEC/SCHED", "code_information": [{"code": "92960", "type": "CPT"}, {"code": "6102960", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 389.05, "gross_charge": 3202.0, "discounted_cash": 2401.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 389.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTIVE", "code_information": [{"code": "92960", "type": "CPT"}, {"code": "6292960", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 389.05, "gross_charge": 3202.0, "discounted_cash": 2401.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 389.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC INT", "code_information": [{"code": "92961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 866.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 288.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 649.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 317.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 177.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 177.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 287.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 287.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 45 M", "code_information": [{"code": "G0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 450.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 150.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 636.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 636.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 75 M", "code_information": [{"code": "G0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 762.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 762.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 30 M", "code_information": [{"code": "G0086", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 271.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 380.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 380.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 269.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 443.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 443.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 147.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 582.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 762.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 762.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MANAGE BEH SVS 20MINS", "code_information": [{"code": "G0323", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.74, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 67.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 160.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARE OF MISCARRIAGE", "code_information": [{"code": "59820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1418.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING 1ST 30 MIN", "code_information": [{"code": "97550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 195.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 195.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREGIVER TRAING EA ADDL 15", "code_information": [{"code": "97551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 97.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAREPATCH PER SQ CM", "code_information": [{"code": "Q4236", "type": "HCPCS"}], "standard_charges": [{"minimum": 3292.85, "maximum": 3292.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3292.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS HIGH RISK", "code_information": [{"code": "D0603", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.63, "maximum": 26.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS LOW RISK", "code_information": [{"code": "D0601", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.63, "maximum": 26.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS MOD RISK", "code_information": [{"code": "D0602", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.63, "maximum": 26.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIES SUSCEPTIBILITY TEST", "code_information": [{"code": "D0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.04, "maximum": 115.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIPRAZINE 3MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302055", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 313.0, "discounted_cash": 234.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARIPRAZINE 3MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302055", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 313.0, "discounted_cash": 234.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARISOPRODOL 350MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302058", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARISOPRODOL 350MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302058", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARMUSTINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 1029.67, "maximum": 1029.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21085.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35285.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44556.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARPAL TUNNEL SURGERY", "code_information": [{"code": "64721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 23534.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1619.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO +30MIN", "code_information": [{"code": "94781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARTG SUTURE FIX DIGITEX", "code_information": [{"code": "C2631", "type": "HCPCS"}, {"code": "8193105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARVEDILOL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302079", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302079", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302080", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302080", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 3.125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 3.125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302077", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 6.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302078", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARVEDILOL 6.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302078", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT", "code_information": [{"code": "T1016", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT, PER MONTH", "code_information": [{"code": "T2022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASE PRESENTATION TX PLAN", "code_information": [{"code": "D9450", "type": "HCPCS"}], "standard_charges": [{"minimum": 129.99, "maximum": 129.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT", "code_information": [{"code": "M0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1677.83, "maximum": 1677.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT HM", "code_information": [{"code": "M0241", "type": "HCPCS"}], "standard_charges": [{"minimum": 2796.39, "maximum": 2796.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2796.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI 1200 MG", "code_information": [{"code": "Q0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI 600 MG", "code_information": [{"code": "Q0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ", "code_information": [{"code": "M0243", "type": "HCPCS"}], "standard_charges": [{"minimum": 1677.83, "maximum": 1677.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ HM", "code_information": [{"code": "M0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2796.39, "maximum": 2796.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2796.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASIRIVIMAB AND IMDEVIMAB", "code_information": [{"code": "Q0243", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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[{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATARACT SURG W/IOL 1 STAGE", "code_information": [{"code": "66983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL BI-DIR IRRIGATD", "code_information": [{"code": "C2630", "type": "HCPCS"}, {"code": "8055015", "type": "CDM"}, 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{"description": "CATH ABL RF ENDOVENOUS", "code_information": [{"code": "C1888", "type": "HCPCS"}, {"code": "8055010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 7177.0, "discounted_cash": 5382.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH ABL SAFIRE", "code_information": [{"code": "C1733", "type": "HCPCS"}, {"code": "8240028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 36140.0, "discounted_cash": 27105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH ABL THERMOCL BI-DIR", "code_information": [{"code": "C2630", "type": "HCPCS"}, {"code": "8055013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33176.0, "discounted_cash": 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{"description": "CATH PERIT DIAL SHORT", "code_information": [{"code": "C1752", "type": "HCPCS"}, {"code": "4031485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PICC SL BDL POLY", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8245930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 438.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PICC SL NEONATAL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8245942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 366.0, "discounted_cash": 274.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PIGTAIL MERIT AD/PD", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8245960", "type": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 570.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 189.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH PLATFORM LG DSTL TRACSTAR", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8056879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13190.0, "discounted_cash": 9892.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PORT", "code_information": [{"code": "C1788", "type": "HCPCS"}, {"code": "8173370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6615.0, "discounted_cash": 4961.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PRPH DIL OTW VIATRC", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2478.0, "discounted_cash": 1858.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PRPH DIL RX VTRC 14", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2478.0, "discounted_cash": 1858.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA ANGIOSCULPT", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4031495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8260.0, "discounted_cash": 6195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA ARMADA 18 BLLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA ARMADA 35 BLLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 1548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA ARMADA14 BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8058258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2789.0, "discounted_cash": 2091.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA BLN CORDIS OPTA", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA BLN FF ULTRASCORE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9036.0, "discounted_cash": 6777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA BLN PWRFLX", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1526.0, "discounted_cash": 1144.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA CORDIS MAXI LD", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1858.0, "discounted_cash": 1393.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA CORDIS OPTA LP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DIL AVIATOR PLS", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1838.0, "discounted_cash": 1378.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DIL CONQUEST", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1745.0, "discounted_cash": 1308.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DIL CRDIS SAVVY", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 2285.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DIL ULTRAVERSE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3047.0, "discounted_cash": 2285.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DORADO", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4020970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1972.0, "discounted_cash": 1479.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DRUG COATED BLN", "code_information": [{"code": "C2623", "type": "HCPCS"}, {"code": "8056881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16007.0, "discounted_cash": 12005.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DRUG COATED BLN", "code_information": [{"code": "C2623", "type": "HCPCS"}, {"code": "8056886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12391.0, "discounted_cash": 9293.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA DRUG COATED BLN", "code_information": [{"code": "C2623", "type": "HCPCS"}, {"code": "8056891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16007.0, "discounted_cash": 12005.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA EVERCROSS BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 1162.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA FOX PLUS", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "4031494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1526.0, "discounted_cash": 1144.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA IN.PACT ADMIRAL", "code_information": [{"code": "C2623", "type": "HCPCS"}, {"code": "8058260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16007.0, "discounted_cash": 12005.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA MUSTANG BLLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2701.0, "discounted_cash": 2025.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA NANOCROSS 014", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3153.0, "discounted_cash": 2364.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA NANOCRS ELT OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3089.0, "discounted_cash": 2316.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA OTW METACROSS", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11152.0, "discounted_cash": 8364.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA REEF HP BLN OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67794.0, "discounted_cash": 50845.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA SLEEK RX DILTAT", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8058257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1590.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTA SV FOX", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8245969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3822.0, "discounted_cash": 2866.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA APEX OTW BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1705.0, "discounted_cash": 1278.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA APEX RX BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 774.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA BLN MR EMERGE", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 774.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA DIL CHARGER", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 774.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA EMERGE MR US BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1695.0, "discounted_cash": 1271.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA MAVERCK MONORL", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7982.0, "discounted_cash": 5986.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA MAVERICK OTW", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8240846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1731.0, "discounted_cash": 1298.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA SCORING EVO BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7897.0, "discounted_cash": 5922.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PTCA SCORING RX BLN", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8260.0, "discounted_cash": 6195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PWR PICC SOLO DL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "4031501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PWR PICC SOLO TL", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "4031503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH R HRT ART/GRFT ANGI", "code_information": [{"code": "93457", "type": "CPT"}, {"code": "4613457", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30855.75, "gross_charge": 41141.0, "discounted_cash": 30855.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 26741.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 16456.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3157.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 30855.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH R HRT ART/GRFT ANGI", "code_information": [{"code": "93457", "type": "CPT"}, {"code": "4613457", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30855.75, "gross_charge": 41141.0, "discounted_cash": 30855.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETER IVUS", "code_information": [{"code": "C1753", "type": "HCPCS"}, {"code": "8056542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7486.0, "discounted_cash": 5614.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETERIZE FOR URINE SPEC", "code_information": [{"code": "P9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION OF CERVIX", "code_information": [{"code": "57510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 414.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 200.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAVOPULMONARY SHUNTING", "code_information": [{"code": "33768", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1470.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "4100056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "4120056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "4150056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "4170056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC AUTO W/O DIFF", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "7255027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 194.0, "discounted_cash": 145.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITH AUTO DIFF", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "4105028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.47, "gross_charge": 507.0, "discounted_cash": 380.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITH AUTO DIFF", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "4125028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.47, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITH AUTO DIFF", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "4155028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.47, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CBC WITH AUTO DIFF", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "4175028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.47, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, 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"standard_charge_dollar": 217.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 217.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302204", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302204", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302208", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314607", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALEXIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314607", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 18.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHALOTHIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1890", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.96, "maximum": 40.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEPHAPIRIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0710", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.22, "maximum": 6.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERT NURSE MIDWIFE SS", "code_information": [{"code": "G0064", "type": "HCPCS"}], "standard_charges": [{"minimum": 295.29, "maximum": 295.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERTOLIZUMAB PEGOL INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0717", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.27, "maximum": 18.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERULOPLASMIN", "code_information": [{"code": "82390", "type": "CPT"}, {"code": "7252390", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 40.74, "gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV COL THERMPLS FM 2PC", "code_information": [{"code": "L0172", "type": "HCPCS"}, {"code": "8130073", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 664.23, "maximum": 664.23, "gross_charge": 227.0, "discounted_cash": 170.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 664.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL LAMINOPLSTY 2/> SEG", "code_information": [{"code": "63050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8853.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5348.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1816.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17705.0, "maximum": 67565.86, "estimated_discounted_cash": 80367.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32725.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23616.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 34434.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 33264.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31974.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53507.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67565.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "471", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17705.0, "maximum": 110741.41, "estimated_discounted_cash": 75853.5, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32725.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23616.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 56437.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 54520.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 52405.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 87698.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 110741.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17705.0, "maximum": 55988.77, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32725.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23616.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28533.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27564.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26495.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44338.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55988.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9768.95, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9768.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3244.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4855.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1615.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3275.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1090.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11505.27, "maximum": 24312.33, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12390.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11969.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11505.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19253.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24312.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12650.0, "maximum": 56305.26, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28695.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27720.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26645.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44589.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56305.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10395.0, "maximum": 21966.19, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11194.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10814.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10395.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17395.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21966.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12120.63, "maximum": 25612.69, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13053.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12609.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12120.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20283.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25612.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12650.0, "maximum": 37829.63, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19279.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18624.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17902.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29958.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37829.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10405.86, "maximum": 21989.12, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14532.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12650.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14860.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11206.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10825.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10405.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17413.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21989.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 430.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CETUXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 279.62, "maximum": 279.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CETYLPYRDN/BENZ 1 EA LZ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5302250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CETYLPYRDN/BENZ 1 EA LZ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5302250", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CFTR GENE COM VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}], "standard_charges": [{"minimum": 176.1, "maximum": 2111.18, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 176.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 195.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2111.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 500.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 94.44, "maximum": 1650.22, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 94.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 104.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1650.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 391.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE FULL SEQUENCE", "code_information": [{"code": "81223", "type": "CPT"}], "standard_charges": [{"minimum": 268.34, "maximum": 1892.71, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 268.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 298.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1892.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 449.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 75.14, "maximum": 640.07, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 75.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 83.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 640.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 151.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 65.37, "maximum": 368.76, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 65.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 72.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 368.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CH GTUBE TO GJTUBE W/FLU", "code_information": [{"code": "4919446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5236.0, "discounted_cash": 3927.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE BILIARY DRAIN CTH", "code_information": [{"code": "4917515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10462.0, "discounted_cash": 7846.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE CYSTO TB SMPL", "code_information": [{"code": "4912040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3008.0, "discounted_cash": 2256.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE CYSTO TUBE COMPLT", "code_information": [{"code": "4912042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4509.0, "discounted_cash": 3381.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 671.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 927.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 671.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11030.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1702.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 571.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE NEPHROSTOMY TUBE", "code_information": [{"code": "4917520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19536.0, "discounted_cash": 14652.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE NEPHROURETERAL CATH", "code_information": [{"code": "50387", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 5681.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 482.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 635.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 482.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1766.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 291.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 281.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 95.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE PERC DRAIN CATH", "code_information": [{"code": "75984", "type": "CPT"}, {"code": "4915985", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 371.06, "gross_charge": 8180.0, "discounted_cash": 6135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 202.98, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 117.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 333.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 371.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE PERC DRAIN CATH", "code_information": [{"code": "75984", "type": "CPT"}, {"code": "5055984", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 371.06, "gross_charge": 8180.0, "discounted_cash": 6135.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 202.98, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 117.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 333.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 371.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE PERC DRAIN CATH", "code_information": [{"code": "75984", "type": "CPT"}, {"code": "5065984", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 371.06, "gross_charge": 6948.0, "discounted_cash": 5211.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 202.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 117.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 333.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 371.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 769.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 823.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1173.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 823.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERC", "code_information": [{"code": "4917526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16445.0, "discounted_cash": 12333.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 5516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 894.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 772.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1161.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 772.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHAR/SORB50GM/240ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314034", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHAR/SORB50GM/240ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314034", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARCOAL 50GM/240ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314037", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARCOAL 50GM/240ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314037", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1039.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 83.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 400.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 49.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 55.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1039.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 235.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 235.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEM CAUT OF GRANLTJ TISSUE", "code_information": [{"code": "17250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 5698.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 137.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 102.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEM CAUTERY OF TISSUE", "code_information": [{"code": "6904010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEM CAUTERY OF TISSUE", "code_information": [{"code": "6904010", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1503.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 794.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 468.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 772.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 404.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1308.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASY/2", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252397", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.56, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMNESCENT ASY", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "7252396", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.56, "gross_charge": 1519.0, "discounted_cash": 1139.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ADM CNS", "code_information": [{"code": "96450", "type": "CPT"}, {"code": "4916450", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 589.96, "gross_charge": 3521.0, "discounted_cash": 2640.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 589.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO ANTI-NEOPL SQ/IM", "code_information": [{"code": "96401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 260.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO BY OTHER THAN INFUSION", "code_information": [{"code": "Q0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 174.21, "maximum": 174.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO EXTEND IV INFUS W/PUMP", "code_information": [{"code": "G0498", "type": "HCPCS"}], "standard_charges": [{"minimum": 641.59, "maximum": 641.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 641.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 263.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 83.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 565.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 565.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 179.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INF EA ADD HR", "code_information": [{"code": "96415", "type": "CPT"}, {"code": "4546415", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.78, "gross_charge": 462.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INJ IA PUSH", "code_information": [{"code": "96420", "type": "CPT"}, {"code": "4916420", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 370.16, "gross_charge": 1261.0, "discounted_cash": 945.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 370.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 472.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 472.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 302.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV <=1H INIT", "code_information": [{"code": "96413", "type": "CPT"}, {"code": "4546413", "type": "CDM"}, {"code": "335", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 469.65, "gross_charge": 2040.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 469.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 231.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 231.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 363.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 363.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 115.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 462.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 462.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO SQ/IM HORMONAL", "code_information": [{"code": "96402", "type": "CPT"}, {"code": "4546402", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.66, "gross_charge": 852.0, "discounted_cash": 639.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 394.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 253.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 293.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 421.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREMITY 1-4", "code_information": [{"code": "64642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 389.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 444.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 397.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 412.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 1-5", "code_information": [{"code": "64646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 484.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 220.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9074.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 916.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 343.91, "maximum": 343.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 343.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "estimated_discounted_cash": 8270.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 610.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 610.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INJECTION", "code_information": [{"code": "96542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 476.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [{"code": "837", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52141.07, "maximum": 110181.82, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 94160.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 56152.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 54245.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 52141.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 87255.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 110181.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [{"code": "838", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22654.55, "maximum": 47872.43, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40681.02, "methodology": 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"plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLESTYRAMINE 4GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314680", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLESTYRAMINE 4GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314680", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], 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{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE PSEUDO", "code_information": [{"code": "82480", "type": "CPT"}, {"code": "7252480", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.85, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.78, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 144.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 112.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL 15-20 CELL W/BND", "code_information": [{"code": "88262", "type": "CPT"}, {"code": "7270073", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 475.98, "gross_charge": 2596.0, "discounted_cash": 1947.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 242.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 281.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 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[{"code": "88264", "type": "CPT"}, {"code": "7078264", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 548.51, "gross_charge": 1115.0, "discounted_cash": 836.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 242.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 281.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 144.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL 20-25 CELLS", "code_information": [{"code": "88264", "type": "CPT"}, {"code": "7258242", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 548.51, "gross_charge": 1215.0, "discounted_cash": 911.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 242.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 281.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 144.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL 20-25 CELLS", "code_information": [{"code": "88264", "type": "CPT"}, {"code": "7270074", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 548.51, "gross_charge": 1115.0, "discounted_cash": 836.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 242.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 281.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 144.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRM ANAL 5 CELL W/BND", "code_information": [{"code": "88261", "type": "CPT"}, {"code": "7079809", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1002.64, "gross_charge": 1813.0, "discounted_cash": 1359.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 45", "code_information": [{"code": "88263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 570.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 291.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 339.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 157.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 174.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 570.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 135.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 50-100", "code_information": [{"code": "88248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 656.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 336.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 390.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 181.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 201.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 656.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 155.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME BANDING STUDY", "code_information": [{"code": "88283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 260.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 61.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9149.08, "maximum": 19333.36, "estimated_discounted_cash": 59548.45, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13651.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17108.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12946.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12507.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12021.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20118.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25403.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": 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"54161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 26654.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 721.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 242.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 531.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 268.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [{"code": "54150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 28186.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 347.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11462.94, "maximum": 24222.89, "estimated_discounted_cash": 82307.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13364.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12344.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11925.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11462.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19182.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24222.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21360.87, "maximum": 45138.7, "estimated_discounted_cash": 153301.44, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24344.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23004.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22222.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21360.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35746.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45138.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7732.76, "maximum": 16340.48, "estimated_discounted_cash": 44127.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9075.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8327.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8044.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7732.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12940.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16340.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CISATRACURM 2MG/ML 5MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319391", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISATRACURM 2MG/ML10MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319392", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISATRACURM10MG/ML20MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319390", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3665.0, "discounted_cash": 2748.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISPLATIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9060", "type": "HCPCS"}, {"code": "5319398", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 15.32, "maximum": 15.32, "gross_charge": 422.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISPLATIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9060", "type": "HCPCS"}, {"code": "5319398", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 15.32, "maximum": 15.32, "gross_charge": 422.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISTERNOGRAM", "code_information": [{"code": "78630", "type": "CPT"}, {"code": "5208630", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1394.39, "gross_charge": 6265.0, "discounted_cash": 4698.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 557.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302773", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302773", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITALOPRAM 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302772", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITALOPRAM 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302772", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITRATE", "code_information": [{"code": "82507", "type": "CPT"}, {"code": "7252508", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 105.45, "gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 62.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 29.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 32.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITRATE MG 300ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CITRATE MG 300ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5314754", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CK MB FRACTION", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "4102553", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.81, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CK MB FRACTION", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "4122553", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.81, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CK MB FRACTION", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "4172553", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.81, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CK MB FRACTION", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "7252553", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.81, "gross_charge": 372.0, "discounted_cash": 279.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7462.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7462.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2492.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4974.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1667.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302780", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302781", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302781", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARITHROMYCIN 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314762", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLAVICLE COMPLETE", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "4903000", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.53, "gross_charge": 1211.0, "discounted_cash": 908.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 85.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 95.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CAVITY", "code_information": [{"code": "69222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 502.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 247.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 831.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 172.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 284.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 95.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF TEAR DUCT", "code_information": [{"code": "68530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 918.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEVIDIPINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0759", "type": "HCPCS"}, {"code": "5319409", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEVIDIPINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0759", "type": "HCPCS"}, {"code": "5319409", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 30ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334866", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 30ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334866", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 60ML LT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334843", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 60ML LT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334843", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 565.0, "discounted_cash": 423.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 60ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334867", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 518.0, "discounted_cash": 388.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 1% 60ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334867", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 518.0, "discounted_cash": 388.5, 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3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLONIDINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0735", "type": "HCPCS"}, {"code": "5319440", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 73.08, "maximum": 73.08, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLONIDINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0735", "type": "HCPCS"}, {"code": "5319440", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 73.08, "maximum": 73.08, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302970", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302970", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302965", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOPIDOGREL 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302965", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLORAZEPATE 3.75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302976", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLORAZEPATE 3.75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302976", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLORAZEPATE 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302980", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLORAZEPATE 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5302980", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSD RDUCTN SPLINT ALVEOLUS", "code_information": [{"code": "D7670", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2224.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2780.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 933.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9976.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3333.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3236.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1082.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4208.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1410.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2443.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 809.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7001.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7001.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2338.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7187.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7187.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2400.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5328.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1786.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5704.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1912.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 530.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 76.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 261.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 76.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 174.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2269.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 757.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TMP MANIPULATION", "code_information": [{"code": "D7820", "type": "HCPCS"}], "standard_charges": [{"minimum": 1000.82, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1000.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2357.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 982.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/MANIPULJ", "code_information": [{"code": "21401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1214.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 620.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [{"code": "21400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 627.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [{"code": "21337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1109.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/MANJ", "code_information": [{"code": "22315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2864.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 127.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1118.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 127.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1101.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 387.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4105006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 281.0, "discounted_cash": 210.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4125006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4155006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM IA", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "4175006", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 346.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1314.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "D7983", "type": "HCPCS"}], "standard_charges": [{"minimum": 1891.27, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1891.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VAGINA", "code_information": [{"code": "57120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1949.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 647.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6135.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2050.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5956.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1991.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1221.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 537.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3990.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1338.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3205.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR FLETCHER FACT", "code_information": [{"code": "85292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR II PRTHRMBN", "code_information": [{"code": "85210", "type": "CPT"}, {"code": "7255210", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.23, "gross_charge": 941.0, "discounted_cash": 705.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR V (LABILE)", "code_information": [{"code": "85220", "type": "CPT"}, {"code": "7255220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.95, "gross_charge": 379.0, "discounted_cash": 284.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII(STABLE)", "code_information": [{"code": "85230", "type": "CPT"}, {"code": "7255230", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.89, "gross_charge": 422.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII RELTD ANTGN", "code_information": [{"code": "85244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR WGHT KININOGEN", "code_information": [{"code": "85293", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN SCRN", "code_information": [{"code": "85291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FCTR IX(PTC/XMAS)", "code_information": [{"code": "85250", "type": "CPT"}, {"code": "7255250", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.22, "gross_charge": 808.0, "discounted_cash": 606.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 72.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOT FCTR VIII(AHG)1 STG", "code_information": [{"code": "85240", "type": "CPT"}, {"code": "7255240", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.89, "gross_charge": 1050.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"code_information": [{"code": "21315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 217.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX W/MNPJ&STABLJ", "code_information": [{"code": "21320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 346.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 262.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1151.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 387.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1226.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC WO MNPJ", "code_information": [{"code": "23540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1263.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 459.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [{"code": "23500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 869.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX W/MNPJ", "code_information": [{"code": "23625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1333.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 484.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 987.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 347.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1654.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 610.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1166.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 426.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1098.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1680.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1200.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 427.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1605.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1431.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 522.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 922.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1879.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1508.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 552.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ W/ANES", "code_information": [{"code": "23655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1526.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 512.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ WO ANES", "code_information": [{"code": "23650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1733.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1138.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1372.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 908.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1646.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 549.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2017.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 678.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CMBN ANT PST COLPRHY", "code_information": [{"code": "57260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 38471.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2850.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 948.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3187.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1060.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH 10-20MIN", "code_information": [{"code": "G9869", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 132.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH <10MIN", "code_information": [{"code": "G9868", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI ASYNTELEHEALTH >20MIN", "code_information": [{"code": "G9870", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 55.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMMI MOD HOME VISIT", "code_information": [{"code": "G9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 173.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 57.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMP EP ABL INTRA AFIB PVI EP3D", "code_information": [{"code": "93656", "type": "CPT"}, {"code": "4613663", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32881.5, "gross_charge": 43842.0, "discounted_cash": 32881.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 28497.3, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 17536.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3347.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 32881.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1116.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMP EP ABL INTRA AFIB PVI EP3D", "code_information": [{"code": "93656", "type": "CPT"}, {"code": "4613663", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32881.5, "gross_charge": 43842.0, "discounted_cash": 32881.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 28497.3, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 17536.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3347.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 32881.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1116.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMP FEM OXI GN REN OXLEG SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38206.0, "discounted_cash": 28654.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CMP FEM UNCTD SPHERE MEDACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CMP FEM UNCTD SPHERE MEDACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17674.0, "discounted_cash": 13255.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 1.1-2.5 CM", "code_information": [{"code": "13151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1008.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L 2.6-7.5 CM", "code_information": [{"code": "13152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1215.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 599.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [{"code": "13153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 492.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 224.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 877.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 468.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1096.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 567.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "13133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 452.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [{"code": "13120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 427.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 2.6-7.5 CM", "code_information": [{"code": "13121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 935.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 512.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L ADDL 5 CM/>", "code_information": [{"code": "13122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 297.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 1.1-2.5 CM", "code_information": [{"code": "13100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 727.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 2.6-7.5 CM", "code_information": [{"code": "13101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 895.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 158.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 477.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 158.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK ADDL 5CM/<", "code_information": [{"code": "13102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"minimum": 5830.75, "maximum": 5830.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5830.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMV QUANT", "code_information": [{"code": "87497", "type": "CPT"}, {"code": "7257499", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 162.49, "gross_charge": 1940.0, "discounted_cash": 1455.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 83.19, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 96.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 44.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 123.3, "maximum": 519.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CNS PATHOGENS 12-25", "code_information": [{"code": "87483", "type": "CPT"}, {"code": "7257483", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1580.85, "gross_charge": 2740.0, "discounted_cash": 2055.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", 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{"description": "COLD AGGLUTINATN TITER", "code_information": [{"code": "86157", "type": "CPT"}, {"code": "7026015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.57, "gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.67, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTINATN TITER", "code_information": [{"code": "86157", "type": "CPT"}, {"code": "7256015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.57, "gross_charge": 146.0, "discounted_cash": 109.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.67, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ SCREEN", "code_information": [{"code": "86156", "type": "CPT"}, {"code": "7256156", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.61, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7885.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7885.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2637.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8082.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8082.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2702.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLESTIPOL 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLESTIPOL 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303044", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLESTIPOL 5GM PK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314848", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLESTIPOL 5GM PK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314848", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1965.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "418U", "type": "CPT"}], "standard_charges": [{"minimum": 481.1, "maximum": 2678.81, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 481.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 534.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2678.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHA UPTO150MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0770", "type": "HCPCS"}, {"code": "5319491", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 52.78, "maximum": 52.78, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHA UPTO150MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0770", "type": "HCPCS"}, {"code": "5319491", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 52.78, "maximum": 52.78, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHATE INH SOL MG", "code_information": [{"code": "S0142", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.44, "maximum": 1.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSS LINKS", "code_information": [{"code": "82523", "type": "CPT"}, {"code": "7252523", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.85, "gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSS LINKS/2", "code_information": [{"code": "82523", "type": "CPT"}, {"code": "7252524", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.85, "gross_charge": 326.0, "discounted_cash": 244.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MICROFIB 1GM PW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5336610", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1413.0, "discounted_cash": 1059.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGEN SKIN TEST", "code_information": [{"code": "Q3031", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE PER DOSE OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE PER DOSE OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE, CLOST HIST INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0775", "type": "HCPCS"}], "standard_charges": [{"minimum": 251.36, "maximum": 251.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE250U/GM30GMOI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334958", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1202.0, "discounted_cash": 901.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAGENASE250U/GM30GMOI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334958", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1202.0, "discounted_cash": 901.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAR CERV MULT ADJ", "code_information": [{"code": "L0190", "type": "HCPCS"}, {"code": "8131541", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 2756.18, "maximum": 2756.18, "gross_charge": 354.0, "discounted_cash": 265.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2756.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT & APPL BLOOD PRODUCT", "code_information": [{"code": "D7921", "type": "HCPCS"}], "standard_charges": [{"minimum": 388.48, "maximum": 388.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 388.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT & PREP SALIVA SAMPLE", "code_information": [{"code": "D0417", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.8, "maximum": 44.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD FROM PICC", "code_information": [{"code": "36592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLECTION OF MICROORGANISMS", "code_information": [{"code": "D0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 213.13, "maximum": 213.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 197.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLODION FLEX 120ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5334963", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCREEN;BARIUM ENEMA", "code_information": [{"code": "G0106", "type": "HCPCS"}], "standard_charges": [{"minimum": 582.34, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN NOT HI RSK IND", "code_information": [{"code": "G0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 7801.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 664.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 582.34, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1001.12, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1001.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN;BLD-BSD BIOMRK", "code_information": [{"code": "G0327", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON DBL CM STUDY INCLD GLUC", "code_information": [{"code": "74280", "type": "CPT"}, {"code": "4904280", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 745.87, "gross_charge": 3720.0, "discounted_cash": 2790.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 250.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 671.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 745.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 583.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 188.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 491.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 491.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON SNGL CM STUDY", "code_information": [{"code": "74270", "type": "CPT"}, {"code": "4904270", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 543.81, "gross_charge": 2884.0, "discounted_cash": 2163.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 214.81, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 190.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 543.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 4L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314381", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONIC LAVAGE 4L PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314381", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY & POLYPECTOMY", "code_information": [{"code": "44392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 717.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 200.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 468.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 200.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY AND BIOPSY", "code_information": [{"code": "45380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6129.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 721.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 246.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 246.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR BLEEDING", "code_information": [{"code": "44391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 828.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 428.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 428.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR FOREIGN BODY", "code_information": [{"code": "44390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 755.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 206.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 486.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 206.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY SUBMUCOUS NJX", "code_information": [{"code": "45381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 5887.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 720.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 256.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 256.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THRU STOMA SPX", "code_information": [{"code": "44388", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 561.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 381.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6677.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 970.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2249.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2787.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2249.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BALLOON DILAT", "code_information": [{"code": "45386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 761.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 717.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 416.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BAND LIGATION", "code_information": [{"code": "45398", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7729.0, "estimated_discounted_cash": 4064.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 845.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 612.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 959.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 612.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/CONTROL BLEED", "code_information": [{"code": "45382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 928.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 426.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 783.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 426.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 831.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 902.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DILATION", "code_information": [{"code": "44405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 659.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 653.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 925.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPIC FNB", "code_information": [{"code": "45392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1092.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/FB REMOVAL", "code_information": [{"code": "45379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 856.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 208.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 208.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 617.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 262.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 501.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 262.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6013.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 819.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 274.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 583.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 274.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/LESION REMOVAL", "code_information": [{"code": "45385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6489.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 912.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 213.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 544.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 213.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 987.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 330.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1092.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1193.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 398.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/SNARE", "code_information": [{"code": "44394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 809.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 226.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 226.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 938.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1039.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2197.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2692.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2197.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH BIOPSY", "code_information": [{"code": "44389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 617.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 253.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 253.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLORECTAL SCRN; HI RISK IND", "code_information": [{"code": "G0105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 7630.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4347.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1456.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3649.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1218.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [{"code": "57282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "estimated_discounted_cash": 15612.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2541.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 845.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2559.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 852.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "429", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25534.0, "maximum": 206626.17, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25534.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 105304.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 101727.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 97781.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 163632.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 206626.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC", "code_information": [{"code": "430", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25534.0, "maximum": 132262.67, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25534.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 67405.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 65116.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 62590.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104742.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 132262.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS ADD 30 M", "code_information": [{"code": "G0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 61.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM HLTH INTG SVS SDOH 60MN", "code_information": [{"code": "G0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 182.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMM SVCS BY RHC/FQHC 5 MIN", "code_information": [{"code": "G0071", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.34, "maximum": 63.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMMISSURE SPLINT", "code_information": [{"code": "D5987", "type": "HCPCS"}], "standard_charges": [{"minimum": 1041.82, "maximum": 1041.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1041.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP ASSES CARE PLAN CCM SVC", "code_information": [{"code": "G0506", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 160.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP EP ABL AFIB ADTNL", "code_information": [{"code": "93657", "type": "CPT"}, {"code": "4613664", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 29358.75, "gross_charge": 39145.0, "discounted_cash": 29358.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 25444.25, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 15658.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1083.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 29358.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 362.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP EP EVAL/LA FRM CS R", "code_information": [{"code": "93621", "type": "CPT"}, {"code": "4610610", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 27540.0, "discounted_cash": 20655.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3984.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP EP EVAL/LV RECORD", "code_information": [{"code": "93622", "type": "CPT"}, {"code": "4610612", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 24359.0, "discounted_cash": 18269.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3973.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP EP IND/ABLA INTR EP3D SVT", "code_information": [{"code": "93653", "type": "CPT"}, {"code": "4613653", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32638.5, "gross_charge": 43518.0, "discounted_cash": 32638.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 28286.7, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 17407.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2952.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 32638.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 985.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP EP/ABLAT INTRA V-TACH 3D", "code_information": [{"code": "93654", "type": "CPT"}, {"code": "4613654", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32881.5, "gross_charge": 43842.0, "discounted_cash": 32881.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 28497.3, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 17536.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3556.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 32881.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1187.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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503.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 170.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPL RPLCMT PICC RS&I", "code_information": [{"code": "36584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 274.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 377.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 274.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPL ZIFT CASE RATE", "code_information": [{"code": "S4014", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "4126332", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.52, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "4156332", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.52, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "4176159", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.52, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": 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"standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT AG EA", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "7256136", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.52, "gross_charge": 535.0, "discounted_cash": 401.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT C3", "code_information": [{"code": "86161", "type": "CPT"}, {"code": "7251277", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.52, "gross_charge": 141.0, "discounted_cash": 105.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL CH50", "code_information": [{"code": "86162", "type": "CPT"}, {"code": "7256162", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.07, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL CH50/2", "code_information": [{"code": "86162", "type": "CPT"}, {"code": "7256166", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.07, "gross_charge": 1045.0, "discounted_cash": 783.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE ACA, PER SQ CM", "code_information": [{"code": "Q4302", "type": "HCPCS"}], "standard_charges": [{"minimum": 6109.57, "maximum": 6109.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6109.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE FT PER SQ CM", "code_information": [{"code": "Q4271", "type": "HCPCS"}], "standard_charges": [{"minimum": 6383.62, "maximum": 6383.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6383.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE IVF NOS CASE RATE", "code_information": [{"code": "S4015", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9952", "type": "HCPCS"}], "standard_charges": [{"minimum": 545.66, "maximum": 545.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 545.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE REMOVAL OF VULVA", "code_information": [{"code": "56625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2459.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 816.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8512.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2844.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLEX CYSTOMETROGRAM", "code_information": [{"code": "51726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 790.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 234.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX E/M VISIT ADD ON", "code_information": [{"code": "G2211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11759.23, "maximum": 24848.99, "estimated_discounted_cash": 72840.03, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15843.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12663.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12233.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11759.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19678.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24848.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21295.76, "maximum": 45001.09, "estimated_discounted_cash": 77480.38, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28067.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22934.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22155.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21295.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35637.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45001.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8688.91, "maximum": 18360.96, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11059.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9357.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9039.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8688.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14540.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18360.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10877.96, "maximum": 22986.75, "estimated_discounted_cash": 74129.91, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14350.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11714.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11316.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10877.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18203.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22986.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19869.67, "maximum": 41987.57, "estimated_discounted_cash": 117541.49, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24403.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21398.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20671.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19869.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33250.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41987.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7471.21, "maximum": 15787.77, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9618.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8046.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7772.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7471.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12502.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15787.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPNENT HUM STM FRE DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17286.0, "discounted_cash": 12964.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEM COAT DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13374.0, "discounted_cash": 10030.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FEM PFJ ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45662.0, "discounted_cash": 34246.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPONENT FX PHALANGEAL", "code_information": [{"code": "L8642", "type": "HCPCS"}, {"code": "8131549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1540.0, "maximum": 1540.0, "gross_charge": 6504.0, "discounted_cash": 4878.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPONENT VEN OUTFLOW", "code_information": [{"code": "C1750", "type": "HCPCS"}, {"code": "8173799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41303.0, "discounted_cash": 30977.25, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1241.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 412.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 481.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 281.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPOSITE SKIN GRAFT", "code_information": [{"code": "15760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2549.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1033.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPR REV MATERIAL", "code_information": [{"code": "88325", "type": "CPT"}, {"code": "7040098", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 567.7, "gross_charge": 1456.0, "discounted_cash": 1092.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 168.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 356.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 91.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 101.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPR REV MATERIAL", "code_information": [{"code": "88325", "type": "CPT"}, {"code": "7058832", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 567.7, "gross_charge": 1456.0, "discounted_cash": 1092.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 168.04, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 356.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 91.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 101.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charge_dollar": 75497.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 72568.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 121440.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 153348.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11923.11, "maximum": 25195.29, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13968.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12840.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12404.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11923.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19952.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25195.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14671.09, "maximum": 31002.18, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22884.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15799.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15263.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14671.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24551.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31002.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8934.19, "maximum": 18879.27, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10712.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9621.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9294.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8934.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14950.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18879.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONDITIONING PLAY AUDIOMETRY", "code_information": [{"code": "92582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 314.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 108.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT BOTH JAWS", "code_information": [{"code": "D0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.8, "maximum": 450.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT & INTERP", "code_information": [{"code": "D0364", "type": 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"facility"}]}, {"description": "CONE BEAM CT CAPTURE LIMITED", "code_information": [{"code": "D0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.8, "maximum": 450.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPTURE TMJ", "code_information": [{"code": "D0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 659.98, "maximum": 659.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 659.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERP BOTH JAW", "code_information": [{"code": "D0367", "type": "HCPCS"}], "standard_charges": [{"minimum": 564.28, "maximum": 564.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAN", "code_information": [{"code": "D0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 564.28, "maximum": 564.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAX", "code_information": [{"code": "D0366", "type": "HCPCS"}], "standard_charges": [{"minimum": 564.28, "maximum": 564.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE TMJ", "code_information": [{"code": "D0368", "type": "HCPCS"}], "standard_charges": [{"minimum": 826.65, "maximum": 826.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 826.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONFORMITY EVALUATION", "code_information": [{"code": "V5020", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.41, "maximum": 157.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 157.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONGO RED BLOOD TEST", "code_information": [{"code": "P2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 18.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONIVAPTAN PER 1MG PMXIJ", "code_information": [{"code": "C9488", "type": "HCPCS"}, {"code": "5319504", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONIVAPTAN PER 1MG PMXIJ", "code_information": [{"code": "C9488", "type": "HCPCS"}, {"code": "5319504", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1092.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE 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"standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROG SYN1.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303055", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROG SYN1.25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303055", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303065", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .45MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .45MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .625MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJ ESTROGEN .625MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303069", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUGAT ESTRGN 30GM VCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5334998", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2299.0, "discounted_cash": 1724.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONJUGAT ESTRGN 30GM VCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5334998", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2299.0, "discounted_cash": 1724.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONN TRNSVRS ROD TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4648.0, "discounted_cash": 3486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12517.85, "maximum": 26452.08, "estimated_discounted_cash": 64302.28, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17061.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13480.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13023.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12517.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20948.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26452.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26933.89, "maximum": 56915.31, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36919.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 29006.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28020.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26933.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45072.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56915.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9075.28, "maximum": 19177.41, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11633.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9773.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9441.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9075.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15187.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19177.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONNECTOR IMP ALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7228.0, "discounted_cash": 5421.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR NERVE AXOGUARD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4021024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19114.0, "discounted_cash": 14335.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2600.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 872.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4754.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1594.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5954.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1996.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6031.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6031.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2009.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3031.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1007.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7215.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7215.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2422.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8293.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8293.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2783.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7868.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2640.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2019.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 670.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT INC PREP OF SLIDES", "code_information": [{"code": "D0485", "type": "HCPCS"}], "standard_charges": [{"minimum": 213.13, "maximum": 213.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT SLIDES PREP ELSEWHER", "code_information": [{"code": "D0484", "type": "HCPCS"}], "standard_charges": [{"minimum": 194.96, "maximum": 194.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN ADD", "code_information": [{"code": "88332", "type": "CPT"}, {"code": "4120048", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.65, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN ADD", "code_information": [{"code": "88332", "type": "CPT"}, {"code": "4308332", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.65, "gross_charge": 774.0, "discounted_cash": 580.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN SEC", "code_information": [{"code": "88331", "type": "CPT"}, {"code": "4120046", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.01, "gross_charge": 69.0, "discounted_cash": 51.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.88, "methodology": "fee 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HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULT/FROZEN SEC", "code_information": [{"code": "88331", "type": "CPT"}, {"code": "4308331", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 150.01, "gross_charge": 1354.0, "discounted_cash": 1015.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.88, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 64.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 150.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 49.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 12.39, "maximum": 262.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 262.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT AER MED OBSTR 1STHR", "code_information": [{"code": "94644", "type": "CPT"}, {"code": "5504644", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 216.47, "gross_charge": 896.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT AER MED OBSTR ADDHR", "code_information": [{"code": "94645", "type": "CPT"}, {"code": "5504645", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.17, "gross_charge": 896.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PHYS/QHP EQP", "code_information": [{"code": "95250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 535.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 535.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 173.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 236.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 236.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT INTRAOP NEURO MONITOR", "code_information": [{"code": "G0453", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONT RENAL REPLACE THRPY", "code_information": [{"code": "90945", "type": "CPT"}, {"code": "5601100", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 310.91, "gross_charge": 7764.0, "discounted_cash": 5823.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 310.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONT RENAL REPLACE THRPY", "code_information": [{"code": "90945", "type": "CPT"}, {"code": "5601100", "type": "CDM"}, {"code": "821", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 310.91, "gross_charge": 7764.0, "discounted_cash": 5823.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 310.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LAYER <= 16 SQ IN", "code_information": [{"code": "A6206", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.89, "maximum": 10.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 186.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 124.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA OU", "code_information": [{"code": "92312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 221.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 221.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING FOR TX", "code_information": [{"code": "92071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING OU", "code_information": [{"code": "92310", "type": "CPT"}], "standard_charges": [{"minimum": 45.42, "maximum": 364.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 364.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS/ES OTHER TYPE", "code_information": [{"code": "V2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2703.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 910.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTOUR OF FACE BONE LESION", "code_information": [{"code": "21029", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2290.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 949.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case 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"standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1146.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 289.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1149.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1276.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 181.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY GALLBLADDER", "code_information": [{"code": "74290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 92.61, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 88.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 216.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 240.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH 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"CONTRAST X-RAY OF ANKLE", "code_information": [{"code": "73615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 368.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 207.9, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 115.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 314.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 349.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 366.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 497.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 398.09, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 448.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 497.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 71.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 130.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ELBOW", "code_information": [{"code": "73085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 368.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 205.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 115.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 295.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 328.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": 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"standard_charge_dollar": 367.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1515.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 505.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1668.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1864.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 622.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 864.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 188.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 826.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 793.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 256.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 418.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 256.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 591.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 198.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1545.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 515.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1902.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 635.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRST EVAL EXISTNG CVD", "code_information": [{"code": "4906598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTRST EVAL EXISTNG CVD", "code_information": [{"code": "4916598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 694.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 711.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1032.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 711.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVERT EXT BILI DRAIN", "code_information": [{"code": "4917986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32267.0, "discounted_cash": 24200.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 678.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 737.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1054.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 737.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"code": "7256029", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 370.0, "discounted_cash": 277.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPING", "code_information": [{"code": "D2975", "type": "HCPCS"}], "standard_charges": [{"minimum": 710.35, "maximum": 710.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "7250398", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.07, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER CL .4MG/ML10MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319518", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 270.0, "discounted_cash": 202.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER CU 64 DOTATATE DIAG", "code_information": [{"code": "A9592", "type": "HCPCS"}], "standard_charges": [{"minimum": 4161.87, "maximum": 4161.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4161.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER SULF 4MG/10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319519", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPPER/2", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "7252511", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.07, "gross_charge": 1323.0, "discounted_cash": 992.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 1185.31, "maximum": 6599.82, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1185.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1317.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6599.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1566.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/FFR", "code_information": [{"code": "C7557", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGPLSTY ADD", "code_information": [{"code": "92921", "type": "CPT"}, {"code": "4612921", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "gross_charge": 3444.0, "discounted_cash": 2583.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 2238.6, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1377.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2583.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ANGPLSTY INIT", "code_information": [{"code": "92920", "type": "CPT"}, {"code": "4612919", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "gross_charge": 17137.0, "discounted_cash": 12852.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 11139.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 6854.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1867.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 12852.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 624.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3982.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1477.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 976.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1084.81, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2330.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ATHERECT APLAS INIT", "code_information": [{"code": "92924", "type": "CPT"}, {"code": "4612924", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "gross_charge": 21148.0, "discounted_cash": 15861.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 13746.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 8459.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2228.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 15861.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 743.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DOUBLE OSTEOT", "code_information": [{"code": "28299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 21717.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA 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"standard_charge_dollar": 2193.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 430.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 430.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS DSTL MTAR OSTEO", "code_information": [{"code": "28296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20967.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1894.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 383.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 383.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS JT ARTHRD", "code_information": [{"code": "28297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2214.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 435.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1221.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 435.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX MTAR OSTEOT", "code_information": [{"code": "28295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2215.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 460.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1248.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 460.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX PHLX OSTEOT", "code_information": [{"code": "28298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 22648.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1872.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 337.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1003.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 337.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS RSC PRX PHLX BS", "code_information": [{"code": "28292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1794.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 219.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 849.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 219.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR STNT ANGIO ADD", "code_information": [{"code": "92929", "type": "CPT"}, {"code": "4612929", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR STNT ANGIO INIT", "code_information": [{"code": "92928", "type": "CPT"}, {"code": "4612928", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2078.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD HARVESTING", "code_information": [{"code": "S2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD-DERIVED STEM-CELL", "code_information": [{"code": "S2142", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE BUILD-UP INCL ANY PINS", "code_information": [{"code": "D2950", "type": "HCPCS"}], "standard_charges": [{"minimum": 337.61, "maximum": 337.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "estimated_discounted_cash": 10671.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 545.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 990.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORETEXT OR PROTEXT, PER CC", "code_information": [{"code": "Q4246", "type": "HCPCS"}], "standard_charges": [{"minimum": 11257.62, "maximum": 11257.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11257.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORF RELATED SERV 15 MINS EA", "code_information": [{"code": "G0409", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 268.62, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 241.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 268.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 366.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 139.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5658.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4127.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1372.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4535.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1505.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4561.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1513.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4547.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1508.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4271.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1425.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1850.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 618.23, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4576.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1531.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4757.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1593.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5242.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1754.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 82973.36, "maximum": 175335.02, "estimated_discounted_cash": 1590480.19, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 137981.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 107071.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 89357.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 86321.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 82973.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 138852.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 175335.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59286.68, "maximum": 137981.0, "estimated_discounted_cash": 1445336.08, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 137981.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 71120.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63848.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 61679.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 59286.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 99213.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 125281.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48433.0, "maximum": 193331.33, "estimated_discounted_cash": 1724302.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 48433.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 112541.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 98528.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 95182.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 91489.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 153103.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 193331.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 48433.0, "maximum": 139039.67, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 48433.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 81551.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 70859.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 68452.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 65797.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 110108.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 139039.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "235", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63691.92, "maximum": 134590.47, "estimated_discounted_cash": 1449037.16, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 95954.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 83172.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 68592.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 66262.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63691.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 106585.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134590.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "236", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45461.05, "maximum": 96065.94, "estimated_discounted_cash": 1208086.99, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 95954.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 55292.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 48958.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47295.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 45461.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76076.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 96065.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY CARE INTERMED", "code_information": [{"code": "1990035", "type": "CDM"}, {"code": "214", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CORONARY CARE INTERMED", "code_information": [{"code": "2050035", "type": "CDM"}, {"code": "214", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CORONARY CARE UNIT", "code_information": [{"code": "1990026", "type": "CDM"}, {"code": "210", "type": "RC"}], "standard_charges": [{"gross_charge": 10428.0, "discounted_cash": 7821.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORONARY CARE UNIT", "code_information": [{"code": "2050026", "type": "CDM"}, {"code": "210", "type": "RC"}], "standard_charges": [{"gross_charge": 10428.0, "discounted_cash": 7821.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "323", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21309.0, "maximum": 99244.59, "estimated_discounted_cash": 499785.22, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21309.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 50578.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 48860.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46965.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 78594.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 99244.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "324", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21309.0, "maximum": 72265.03, "estimated_discounted_cash": 336429.34, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21309.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 36828.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35577.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34197.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57228.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72265.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [{"code": "325", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21846.0, "maximum": 73627.31, "estimated_discounted_cash": 228285.96, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21846.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37523.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 36248.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34842.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58307.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73627.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONECTOMY", "code_information": [{"code": "D7251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1056.39, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1056.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONERS AUTOPSY (NECROPSY)", "code_information": [{"code": "88045", "type": "CPT"}], "standard_charges": [{"minimum": 36.1, "maximum": 213.13, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 52.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 52.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 52.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPLEX P, PER CC", "code_information": [{"code": "Q4231", "type": "HCPCS"}], "standard_charges": [{"minimum": 5640.87, "maximum": 5640.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5640.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORPLEX, PER SQ CM", "code_information": [{"code": "Q4232", "type": "HCPCS"}], "standard_charges": [{"minimum": 264.05, "maximum": 264.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT FINGER DEFORMITY", "code_information": [{"code": "26567", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2651.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 881.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2253.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 924.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5382.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1808.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT METACARPAL FLAW", "code_information": [{"code": "26565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2619.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 873.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3805.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1274.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3407.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1144.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 413.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 242.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 474.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 266.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1760.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 432.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1060.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 432.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1471.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 550.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2084.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5931.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1988.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/IMPLT", "code_information": [{"code": "28291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1772.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 827.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/O IMPLT", "code_information": [{"code": "28289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1702.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 233.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 834.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 233.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTICORELIN OVINE TRIFLUTAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0795", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.69, "maximum": 36.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL FREE", "code_information": [{"code": "82530", "type": "CPT"}, {"code": "7252530", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.38, "gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4102533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.83, "gross_charge": 572.0, "discounted_cash": 429.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4122533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.83, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4152533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.83, "gross_charge": 196.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "4172533", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.83, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.66, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COSYNTROPIN PER.25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0834", "type": "HCPCS"}, {"code": "5319589", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 102.84, "maximum": 102.84, "gross_charge": 1279.0, "discounted_cash": 959.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COSYNTROPIN PER.25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0834", "type": "HCPCS"}, {"code": "5319589", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 102.84, "maximum": 102.84, "gross_charge": 1279.0, "discounted_cash": 959.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUPLER ANASTOMOTIC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8173925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 32889.0, "discounted_cash": 24666.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1092.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1519.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1092.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1087.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1331.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1087.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVID 19", "code_information": [{"code": "U0002", "type": "HCPCS"}, {"code": "4100372", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 34.95, "maximum": 194.62, "gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID 19", "code_information": [{"code": "U0002", "type": "HCPCS"}, {"code": "4155241", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 34.95, "maximum": 194.62, "gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID TEST SELF-ADMN/COLLECT", "code_information": [{"code": "K1034", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.52, "maximum": 45.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CP ACE CTD DUAL MOB MEDACTA CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11194.0, "discounted_cash": 8395.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 328.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 328.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 182.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPR", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "5500200", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 661.54, "gross_charge": 5386.0, "discounted_cash": 4039.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 661.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPR CARDIOPULM RESUSC", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "6100535", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 661.54, "gross_charge": 5386.0, "discounted_cash": 4039.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 661.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTR-ASST DIR MS PX", "code_information": [{"code": "20985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 174.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CR51 CHROMATE", "code_information": [{"code": "A9553", "type": "HCPCS"}], "standard_charges": [{"minimum": 1727.41, "maximum": 1727.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1727.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17411.47, "maximum": 36793.02, "estimated_discounted_cash": 129740.63, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19362.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18751.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18114.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17411.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29137.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36793.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11187.27, "maximum": 23640.37, "estimated_discounted_cash": 89027.79, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12889.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12047.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11638.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11187.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18721.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23640.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIAL PROSTHESIS", "code_information": [{"code": "D5924", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9053.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3017.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9901.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9901.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3278.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10925.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10925.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3684.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10608.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10608.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3554.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33744.15, "maximum": 71306.39, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43723.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 36340.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35105.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33744.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56469.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71306.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49345.34, "maximum": 104274.02, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 63191.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 53141.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 51336.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 49345.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82577.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 104274.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "27", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27381.03, "maximum": 57860.19, "estimated_discounted_cash": 152084.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33252.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 29487.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28486.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 27381.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45820.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57860.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"minimum": 73052.63, "maximum": 154371.05, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 81188.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 78673.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 76000.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 73052.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 122250.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 154371.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [{"code": "23", "type": "MS-DRG"}], "standard_charges": [{"minimum": 62190.95, "maximum": 131418.7, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 77126.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 66975.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 64700.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 62190.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104073.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 131418.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [{"code": "24", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42455.85, "maximum": 89715.51, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 54576.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 45722.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44169.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42455.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 71047.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 89715.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "416U", "type": "CPT"}], "standard_charges": [{"minimum": 1580.85, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD C HRT DS 9 GEN 12 VRNTS", "code_information": [{"code": "417U", "type": "CPT"}], "standard_charges": [{"minimum": 2558.28, "maximum": 2558.28, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2558.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2558.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2558.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2558.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2558.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CAD ALYS 3 PRTN 3 PARAM", "code_information": [{"code": "308U", "type": "CPT"}], "standard_charges": [{"minimum": 268.85, "maximum": 1482.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 268.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 298.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1482.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"minimum": 57.62, "maximum": 317.7, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 57.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 64.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CV DS ALY 4 PRTN PLM ALG", "code_information": [{"code": "309U", "type": "CPT"}], "standard_charges": [{"minimum": 268.85, "maximum": 1482.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 268.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 298.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1482.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"minimum": 2173.77, "maximum": 11983.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2173.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2415.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11983.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 488.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 587.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3154.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1048.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 657.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 221.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2958.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 981.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3124.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1033.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR SAC DRAIN", "code_information": [{"code": "68720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2941.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 976.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.02, 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"standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3040.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 640.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 744.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 340.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 377.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3040.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 721.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6329.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2114.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRISIS PSYCHOTHERAPY 60M", "code_information": [{"code": "G0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 688.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 688.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 263.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE E&M 30-74 MIN", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "6100514", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1856.25, "gross_charge": 8250.0, "discounted_cash": 6187.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1856.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 771.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1121.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE E&M 30-74 MIN", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "6169291", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1856.25, "gross_charge": 8250.0, "discounted_cash": 6187.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 771.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1856.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1121.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 50", "code_information": [{"code": "G0509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 689.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 689.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 230.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRIT CARE TELEHEA CONSULT 60", "code_information": [{"code": "G0508", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 748.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 748.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CR E&M ADDL 30", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "6103055", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 388.59, "gross_charge": 1668.0, "discounted_cash": 1251.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 388.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CR E&M ADDL 30", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "6169292", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 388.59, "gross_charge": 1668.0, "discounted_cash": 1251.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 388.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3741.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1253.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT>5 CM DIAM", "code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4182.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1403.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4576.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4576.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1532.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5172.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5172.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1745.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"minimum": 207.34, "maximum": 1143.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 207.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 230.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1143.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROMOLYN NAS5.2MG26ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330563", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROMOLYN NAS5.2MG26ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330563", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM NONCOMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7631", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.91, "maximum": 3.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3503.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1172.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROTAMITON 10% 60GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROTAMITON 10% 60GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASE METAL", "code_information": [{"code": "D2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASED METAL", "code_information": [{"code": "D6781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1310.52, "maximum": 1310.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1310.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST HI NOBLE MET", "code_information": [{"code": "D2780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1520.99, "maximum": 1520.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1520.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D2782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1268.11, "maximum": 1268.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1268.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D6782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1320.19, "maximum": 1320.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1320.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 HIGH NOBLE METAL", "code_information": [{"code": "D6780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1596.09, "maximum": 1596.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1596.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D2783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1606.94, "maximum": 1606.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1606.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D6783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1328.61, "maximum": 1328.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1328.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 RESIN-BASED COMPOS", "code_information": [{"code": "D2712", "type": "HCPCS"}], "standard_charges": [{"minimum": 1225.82, "maximum": 1225.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1225.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL BASE METAL CAST", "code_information": [{"code": "D6791", "type": "HCPCS"}], "standard_charges": [{"minimum": 1176.17, "maximum": 1176.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1176.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST BASE METAL", "code_information": [{"code": "D2791", "type": "HCPCS"}], "standard_charges": [{"minimum": 1183.38, "maximum": 1183.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1183.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST HIGH NOBLE M", "code_information": [{"code": "D2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 1606.94, "maximum": 1606.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1606.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST NOBLE METAL", "code_information": [{"code": "D2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1352.81, "maximum": 1352.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1352.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL HIGH NOBLE METAL", "code_information": [{"code": "D6790", "type": "HCPCS"}], "standard_charges": [{"minimum": 1596.09, "maximum": 1596.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1596.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN FULL NOBLE METAL CAST", "code_information": [{"code": "D6792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1427.87, "maximum": 1427.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN LENGTHEN HARD TISSUE", "code_information": [{"code": "D4249", "type": "HCPCS"}], "standard_charges": [{"minimum": 834.88, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 834.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN BASE METAL", "code_information": [{"code": "D6751", "type": "HCPCS"}], "standard_charges": [{"minimum": 1343.18, "maximum": 1343.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN FUSED BASE M", "code_information": [{"code": "D2751", "type": "HCPCS"}], "standard_charges": [{"minimum": 1352.81, "maximum": 1352.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1352.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6750", "type": "HCPCS"}], "standard_charges": [{"minimum": 2017.19, "maximum": 2017.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2017.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN NOBLE METAL", "code_information": [{"code": "D6752", "type": "HCPCS"}], "standard_charges": [{"minimum": 1679.58, "maximum": 1679.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1679.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ H NOBLE M", "code_information": [{"code": "D2750", "type": "HCPCS"}], "standard_charges": [{"minimum": 1859.86, "maximum": 1859.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1859.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ NOBLE MET", "code_information": [{"code": "D2752", "type": "HCPCS"}], "standard_charges": [{"minimum": 1520.99, "maximum": 1520.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1520.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D2740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1690.46, "maximum": 1690.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1690.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D6740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1343.18, "maximum": 1343.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN REPAIR", "code_information": [{"code": "D2980", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.29, "maximum": 347.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 347.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ BASE METAL", "code_information": [{"code": "D2721", "type": "HCPCS"}], "standard_charges": [{"minimum": 1268.11, "maximum": 1268.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1268.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ HIGH NOBLE ME", "code_information": [{"code": "D2720", "type": "HCPCS"}], "standard_charges": [{"minimum": 1690.46, "maximum": 1690.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1690.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ NOBLE METAL", "code_information": [{"code": "D2722", "type": "HCPCS"}], "standard_charges": [{"minimum": 1438.76, "maximum": 1438.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/BASE METAL", "code_information": [{"code": "D6721", "type": "HCPCS"}], "standard_charges": [{"minimum": 1259.69, "maximum": 1259.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1259.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/NOBLE METAL", "code_information": [{"code": "D6722", "type": "HCPCS"}], "standard_charges": [{"minimum": 1427.87, "maximum": 1427.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN-BASED INDIRECT", "code_information": [{"code": "D2710", "type": "HCPCS"}], "standard_charges": [{"minimum": 846.98, "maximum": 846.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN TITANIUM", "code_information": [{"code": "D6794", "type": "HCPCS"}], "standard_charges": [{"minimum": 1160.39, "maximum": 1160.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1160.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN-INDIRECT RESIN BASED", "code_information": [{"code": "D6710", "type": "HCPCS"}], "standard_charges": [{"minimum": 1268.11, "maximum": 1268.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1268.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN-TITANIUM", "code_information": [{"code": "D2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 1320.19, "maximum": 1320.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1320.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "4106140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 422.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "4126140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "4156140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "4176141", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRP HI SENSITIVITY", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "7256363", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRRT REPL B32/K0/CA2 5L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412063", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 446.0, "discounted_cash": 334.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRRT REPL B32/K2/CA0 5L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412071", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 446.0, "discounted_cash": 334.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRRT REPL B32/K4/CA2.5 5L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412072", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 446.0, "discounted_cash": 334.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYO EMBRYO TRANSF CASE RATE", "code_information": [{"code": "S4037", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYO-CORD, PER SQ CM", "code_information": [{"code": "Q4237", "type": "HCPCS"}], "standard_charges": [{"minimum": 1610.01, "maximum": 1610.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1610.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2783.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5137.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6583.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5137.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4409.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1477.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE SGL PULM TUMOR UNI", "code_information": [{"code": "5052994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21654.0, "discounted_cash": 16240.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 542.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 240.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOCRIT QUAL/SEMI QNT", "code_information": [{"code": "82595", "type": "CPT"}, {"code": "7252595", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "gross_charge": 253.0, "discounted_cash": 189.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITTE EA UNIT", "code_information": [{"code": "P9012", "type": "HCPCS"}, {"code": "4509012", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"minimum": 227.09, "maximum": 227.09, "gross_charge": 2236.0, "discounted_cash": 1677.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 227.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 134.24, "maximum": 364.71, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 328.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 364.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 756.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2152.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2638.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2152.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 411.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 178.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS NEOFORM AG IA", "code_information": [{"code": "87327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM IA", "code_information": [{"code": "87328", "type": "CPT"}, {"code": "4107329", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.42, "gross_charge": 311.0, "discounted_cash": 233.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM IA", "code_information": [{"code": "87328", "type": "CPT"}, {"code": "4177329", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.42, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYST ID BODY FLD EX URN", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "4109363", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.8, "gross_charge": 858.0, "discounted_cash": 643.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYST ID BODY FLD EX URN", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "4159363", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.8, "gross_charge": 858.0, "discounted_cash": 643.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYST ID BODY FLD EX URN", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "4170010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.8, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.48, "methodology": "fee 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"standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 500.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2324.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 855.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT STOOL ADD PATH EA", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "7251279", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.81, "gross_charge": 157.0, "discounted_cash": 117.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 18.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR BACTERIA EXCEPT BLOOD", "code_information": [{"code": "87075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 134.24, "maximum": 4000.93, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1613.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1793.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4000.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 134.24, "maximum": 4161.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1678.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1865.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4161.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC DEF ID", "code_information": [{"code": "87077", "type": "CPT"}, {"code": "4108707", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.65, "gross_charge": 326.0, "discounted_cash": 244.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC DEF ID", "code_information": [{"code": "87077", "type": "CPT"}, {"code": "4128707", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.65, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charges": [{"gross_charge": 15624.0, "discounted_cash": 11718.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP HIP REVISION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15251.0, "discounted_cash": 11438.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP HUMERAL STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 5550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1341.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 470.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURRENT PERCEP THRESHOLD TST", "code_information": [{"code": "G0255", "type": "HCPCS"}], "standard_charges": [{"minimum": 294.75, "maximum": 294.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 294.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUSTOM ABUTMENT", "code_information": [{"code": "D6057", "type": "HCPCS"}], "standard_charges": [{"minimum": 1243.91, "maximum": 1243.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1243.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUSTOM MOLD SHOE REMOV PROST", "code_information": [{"code": "L3250", "type": "HCPCS"}], "standard_charges": [{"minimum": 798.01, "maximum": 798.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 798.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUSTOM SHOES DEPTH INLAY", "code_information": [{"code": "L3230", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.52, "maximum": 410.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 410.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUTTING RAMUS OPEN W/GRAFT", "code_information": [{"code": "D7943", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 15794.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15794.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV CATH OH IABP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8814.0, "discounted_cash": 6610.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CV CATH OH IABP", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14277.0, "discounted_cash": 10707.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CV DS ACS BLD ALG 5 YR SCORE", "code_information": [{"code": "415U", "type": "CPT"}], "standard_charges": [{"minimum": 266.18, "maximum": 1482.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 266.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 295.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1482.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS PLASMA ALYS PRTN BMRK", "code_information": [{"code": "19M", "type": "CPT"}], "standard_charges": [{"minimum": 641.16, "maximum": 641.16, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 641.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 641.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 641.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 641.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 641.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CV DS QUAN ADVSRM/PLSM LPRTN", "code_information": [{"code": "377U", "type": "CPT"}], "standard_charges": [{"minimum": 32.41, "maximum": 180.47, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 32.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 36.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 180.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CVP MULTILUMEN", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8031975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1349.0, "discounted_cash": 1011.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CYANIDE", "code_information": [{"code": "82600", "type": "CPT"}, {"code": "7252600", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.58, "gross_charge": 410.0, "discounted_cash": 307.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANIDE ANTIDOTE KT IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5319669", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4573.0, "discounted_cash": 3429.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANOCOBALAMN UPTO1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3420", "type": "HCPCS"}, {"code": "5319674", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5.47, "maximum": 5.47, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANOCOBALAMN UPTO1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3420", "type": "HCPCS"}, {"code": "5319674", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.47, "maximum": 5.47, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYANOCOBLMN(VIT B12)", "code_information": [{"code": "82607", "type": "CPT"}, {"code": "4102611", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.2, "gross_charge": 588.0, "discounted_cash": 441.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.57, "methodology": "fee 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303304", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYPROHEPTADINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303304", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYRO ABLATION ADRENAL MASS", "code_information": [{"code": "5050696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19892.0, "discounted_cash": 14919.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}, {"code": "7258261", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.25, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO IMPL 4 OR MORE", "code_information": [{"code": "C9740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 19048.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO RX BALO CATH URTL STRX", "code_information": [{"code": "52284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 21028.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 592.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3078.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1887.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1235.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 3848.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1111.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/URETER STRICTURE TX", "code_information": [{"code": "52341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1021.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 342.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICTURE TX", "code_information": [{"code": "52344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 32059.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1327.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITHOTRIPSY", "code_information": [{"code": "52356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1492.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7967.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 500.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1416.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 474.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOGRAPHY 3VW MIN", "code_information": [{"code": "74430", "type": "CPT"}, {"code": "4904434", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 368.12, "gross_charge": 2226.0, "discounted_cash": 1669.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 127.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 272.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 303.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOGRAPHY 3VW MIN", "code_information": [{"code": "74430", "type": "CPT"}, {"code": "4914434", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 368.12, "gross_charge": 1534.0, "discounted_cash": 1150.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 127.11, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 272.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 303.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 950.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 285.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 951.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 283.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY", "code_information": [{"code": "52000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 18675.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 266.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 595.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 228.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 437.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 228.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 653.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 251.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 482.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 251.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 892.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 307.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 623.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 307.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER CATHETER", "code_information": [{"code": "52005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20646.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 344.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND BIOPSY", "code_information": [{"code": "52007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 599.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 297.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 514.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 297.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 859.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 288.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 628.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 598.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 598.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 19312.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 726.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 605.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 605.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 19065.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 883.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 296.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20588.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1037.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 347.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 25253.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1408.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 10237.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 757.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 254.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 585.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 222.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 423.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 222.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 11758.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 949.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1160.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 21212.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 184.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 371.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 184.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 725.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 408.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 706.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 875.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 294.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1005.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 337.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 349.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 998.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 334.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24692.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 545.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 365.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 986.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 547.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 884.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 297.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 946.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 358.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 358.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 560.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 257.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 257.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY CHEMODENERVATION", "code_information": [{"code": "52287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "estimated_discounted_cash": 16907.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 608.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 231.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 231.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY IMPLANT STENT", "code_information": [{"code": "52282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1211.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 406.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY INJECT MATERIAL", "code_information": [{"code": "52327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 929.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 311.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [{"code": "52001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1032.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 163.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 163.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1148.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 385.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY W/BIOPSY(S)", "code_information": [{"code": "52204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20683.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 510.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 248.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 248.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PYELOSCOPE", "code_information": [{"code": "52351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1088.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 365.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/BIOPSY", "code_information": [{"code": "52354", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 12539.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1497.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 502.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1733.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/EXCISE TUMOR", "code_information": [{"code": "52355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/LITHOTRIPSY", "code_information": [{"code": "52353", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12193.0, "estimated_discounted_cash": 21089.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8420.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1406.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7967.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1601.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 536.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/STONE REMOVE", "code_information": [{"code": "52352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 17654.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1271.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 426.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 952.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/ADDL IMPLANT", "code_information": [{"code": "52442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 842.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 988.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 842.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO W/IMPLANT", "code_information": [{"code": "52441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 753.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1099.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1450.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1099.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTURETH BLU LI CYST FL IMG", "code_information": [{"code": "C7554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTAL 3-LAYER PER SQ CM", "code_information": 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"standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTP URINE 3-5 PROBES CMPTR", "code_information": [{"code": "88121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1353.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 810.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 833.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Calcium glucon (fresenius)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0610", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.6, "maximum": 19.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Calcium glucon (wg critical)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0611", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.41, "maximum": 6.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion", "code_information": [{"code": "894T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA 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"standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data 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Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With MCC", "code_information": [{"code": "224", "type": "MS-DRG"}], "standard_charges": [{"minimum": 111792.31, "maximum": 111792.31, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 111792.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without MCC", "code_information": [{"code": "225", "type": "MS-DRG"}], "standard_charges": [{"minimum": 85388.91, "maximum": 85388.91, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 85388.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC", "code_information": [{"code": "226", "type": "MS-DRG"}], "standard_charges": [{"minimum": 101360.9, "maximum": 101360.9, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 101360.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization Without MCC", "code_information": [{"code": "227", "type": "MS-DRG"}], "standard_charges": [{"minimum": 79390.85, "maximum": 79390.85, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79390.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Output Measurements", "code_information": [{"code": "93561", "type": "CPT"}], "standard_charges": [{"minimum": 10.01, "maximum": 10.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiology (coronary artery disease [CAD]), DNA, genome-wide association studies (564856 single-nucleotide polymorphisms [SNPs], targeted variant genotyping), patient lifestyle and clinical data, buccal swab, algorithm reported as polygenic risk to acquir", "code_information": [{"code": "466U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion With CC", "code_information": [{"code": "454", "type": "MS-DRG"}], "standard_charges": [{"minimum": 116820.07, "maximum": 116820.07, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 116820.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion With MCC", "code_information": [{"code": "453", "type": "MS-DRG"}], "standard_charges": [{"minimum": 162643.95, "maximum": 162643.95, "estimated_discounted_cash": 125505.24, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 162643.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion Without CC/MCC", "code_information": [{"code": "455", "type": "MS-DRG"}], "standard_charges": [{"minimum": 91060.62, "maximum": 91060.62, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 91060.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Complete Removal Of Vaginal Wall And Surrounding Tissue With Removal Of Lymph Nodes On Both Sides Of Pelvis And Aortic Lymph Node Biopsy", "code_information": [{"code": "57112", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 7030.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7030.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Complex Motion Imaging Procedure On Both Sides Of Body", "code_information": [{"code": "76102", "type": "CPT"}], "standard_charges": [{"minimum": 230.6, "maximum": 558.33, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 230.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 558.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Complex Motion Imaging Procedure On One Side Of Body", "code_information": [{"code": "76101", "type": "CPT"}], "standard_charges": [{"minimum": 161.27, "maximum": 280.45, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 161.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Comprehensive, Clinical Pathology Consultation", "code_information": [{"code": "80502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 269.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 90.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 121.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat) Scan, Other", "code_information": [{"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 382.0, "maximum": 425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 382.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 425.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Body Scan", "code_information": [{"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 382.0, "maximum": 425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 382.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 425.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, General", "code_information": [{"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 382.0, "maximum": 425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 382.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 425.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Head Scan", "code_information": [{"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 382.0, "maximum": 425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 382.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 425.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Computerized ophthalmic diagnostic imaging (eg, optical coherence tomography [OCT]), posterior segment, with interpretation and report, unilateral or bilateral; retina, including OCT angiography", "code_information": [{"code": "92137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 311.4, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 311.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 311.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 311.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 311.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 311.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Connection Of External Patient-Activated Ekg Event Recorder", "code_information": [{"code": "497T", "type": "CPT"}], "standard_charges": [{"minimum": 787.2, "maximum": 787.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 787.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour, including physiological and laboratory assessments (eg, perfusate temperature, perfusate pH, hemodynamic parameters, bile production, bile pH", "code_information": [{"code": "896T", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory assessments (eg, perfusate temperature, perfusate pH, hemodynamic parameters, bil", "code_information": [{"code": "895T", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Contact Near-Infrared Spectroscopy Of Wound Of Leg", "code_information": [{"code": "493T", "type": "CPT"}], "standard_charges": [{"minimum": 144.06, 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"5303468", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 838.0, "discounted_cash": 628.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN CITRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9151", "type": "HCPCS"}], "standard_charges": [{"minimum": 1046.87, "maximum": 1046.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1046.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9150", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.3, "maximum": 135.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE 1ST 20 SQ CM/<", "code_information": [{"code": "11044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 7738.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 816.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 376.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFECTED SKIN<10%", "code_information": [{"code": "11000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 71.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA 1ST 20/<", "code_information": [{"code": "11043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 8813.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 556.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT MUSC&/FSCA EA ADDL", "code_information": [{"code": "11046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 10424.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT PRMLG LES W/PDT", "code_information": [{"code": "96574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1011.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 327.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN ABDOMINAL WALL", "code_information": [{"code": "11005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2771.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 926.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2512.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 842.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT&PER", "code_information": [{"code": "11004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2041.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 683.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TIS 1ST 20SQCM/<", "code_information": [{"code": "11042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 3204.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 156.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 8722.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "4916593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8441.0, "discounted_cash": 6330.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DCLOT CVAD THROMBL AGNT", "code_information": [{"code": "6296593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8441.0, "discounted_cash": 6330.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DCMPRN PX PERQ 1/MLT LUMBAR", "code_information": [{"code": "62287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2204.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEB BONE 20 CM2 W/DRUG DEV", "code_information": [{"code": "C7500", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEB SKIN BONE AT FX SITE", "code_information": [{"code": "11012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1502.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 248.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 782.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 248.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRID SUBQ 1ST 20 SQ CM OR <", "code_information": [{"code": "6900040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 1783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRID SUBQ 1ST 20 SQ CM OR <", "code_information": [{"code": "6900040", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 1783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE 20SQ CM/<", "code_information": [{"code": "6900044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6616.0, "discounted_cash": 4962.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE 20SQ CM/<", "code_information": [{"code": "6900044", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 6616.0, "discounted_cash": 4962.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE EA ADD 20SQ", "code_information": [{"code": "6900045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5607.0, "discounted_cash": 4205.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE BONE EA ADD 20SQ", "code_information": [{"code": "6900045", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5607.0, "discounted_cash": 4205.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA 20SQCM", "code_information": [{"code": "6900042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7676.0, "discounted_cash": 5757.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA 20SQCM", "code_information": [{"code": "6900042", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 7676.0, "discounted_cash": 5757.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA EA ADD", "code_information": [{"code": "6900043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3308.0, "discounted_cash": 2481.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE MSCL/FSCA EA ADD", "code_information": [{"code": "6900043", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3308.0, "discounted_cash": 2481.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "6900036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "6900036", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "11720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1077.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "6900037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "6900037", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "11721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2751.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN AT FX SITE", "code_information": [{"code": "11010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1002.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 536.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN MUSC AT FX SITE", "code_information": [{"code": "11011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1076.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 213.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SUBQ EA ADD 20SQ", "code_information": [{"code": "6900041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 1783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDE SUBQ EA ADD 20SQ", "code_information": [{"code": "6900041", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2378.0, "discounted_cash": 1783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEBRIDEMENT & CONTOURING", "code_information": [{"code": "D6102", "type": "HCPCS"}], "standard_charges": [{"minimum": 939.03, "maximum": 939.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 939.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF A PERIIMPLANT", "code_information": [{"code": "D6101", "type": "HCPCS"}], "standard_charges": [{"minimum": 537.24, "maximum": 537.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 537.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "4120043", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.33, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "4308311", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.33, "gross_charge": 578.0, "discounted_cash": 433.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION PROCEDURE", "code_information": [{"code": "D0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.46, "maximum": 71.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECITABINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0894", "type": "HCPCS"}, {"code": "5319781", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6.43, "maximum": 6.43, "gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECITABINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0894", "type": "HCPCS"}, {"code": "5319781", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.43, "maximum": 6.43, "gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECLOT VASCULAR DEVICE", "code_information": [{"code": "36593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS DISC RF LUMBAR", "code_information": [{"code": "S2348", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6546.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2191.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3172.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2075.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 700.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2714.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25023", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4791.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1594.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2869.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 961.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4485.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1506.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4622.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1520.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3517.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1183.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD LMBR", "code_information": [{"code": "63056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5429.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1815.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5922.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1982.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63064", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6468.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2150.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8853.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1154.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 387.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8853.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 736.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3377.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1117.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1963.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2270.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 763.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2966.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1003.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1460.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1624.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 540.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1725.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 576.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2036.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 685.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2145.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 721.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2428.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2590.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 870.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF TIBIA NERVE", "code_information": [{"code": "28035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1322.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 647.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8675.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8675.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2900.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8693.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8693.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2886.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DECOR OR SUBMERG ERUPT TOOTH", "code_information": [{"code": "D3921", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP MUSCLE BIOPSY", "code_information": [{"code": "20205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 561.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC", "code_information": [{"code": "294", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15268.31, "maximum": 15268.31, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15268.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC", "code_information": [{"code": "295", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10090.49, "maximum": 10090.49, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10090.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEFEROXAMINE PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0895", "type": "HCPCS"}, {"code": "5319794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 32.61, "maximum": 32.61, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEFEROXAMINE PER500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0895", "type": "HCPCS"}, {"code": "5319794", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 32.61, "maximum": 32.61, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGARELIX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9155", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.88, "maximum": 15.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25212.6, "maximum": 53277.98, "estimated_discounted_cash": 194094.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25663.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27152.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26230.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25212.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42192.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53277.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14061.15, "maximum": 29713.29, "estimated_discounted_cash": 120153.93, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14713.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15142.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14628.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14061.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23530.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29713.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 49.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 57.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDRST SULFATE", "code_information": [{"code": "82627", "type": "CPT"}, {"code": "7252631", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.32, "gross_charge": 213.0, "discounted_cash": 159.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 50.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP ARMS/LEGS", "code_information": [{"code": "15610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 897.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 449.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP EYE/NOS/EAR/LIP", "code_information": [{"code": "15630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1261.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP F/C/C/N/AX/G/H/F", "code_information": [{"code": "15620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1197.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 545.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP TRUNK", "code_information": [{"code": "15600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 779.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 132.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 407.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 132.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 326.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1287.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1287.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 419.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee 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{"description": "DENT SUTUR RECENT WND TO 5CM", "code_information": [{"code": "D7910", "type": "HCPCS"}], "standard_charges": [{"minimum": 467.07, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 467.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENT THERAPEUTIC DRUG INJECT", "code_information": [{"code": "D9610", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.05, "maximum": 68.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9874.06, "maximum": 20865.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12411.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10633.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10272.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9874.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16523.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", 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"type": "HCPCS"}], "standard_charges": [{"minimum": 1310.52, "maximum": 1310.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1310.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METL 4/MORE SUR", "code_information": [{"code": "D2544", "type": "HCPCS"}], "standard_charges": [{"minimum": 1438.76, "maximum": 1438.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 3/MORE SUR", "code_information": [{"code": "D2630", "type": "HCPCS"}], "standard_charges": [{"minimum": 1438.76, "maximum": 1438.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.76, "methodology": "fee 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1352.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 2 SURFACE", "code_information": [{"code": "D2662", "type": "HCPCS"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 3 SURFACE", "code_information": [{"code": "D2663", "type": "HCPCS"}], "standard_charges": [{"minimum": 1352.81, "maximum": 1352.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1352.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 4/MRE SUR", "code_information": [{"code": "D2664", "type": "HCPCS"}], "standard_charges": [{"minimum": 1438.76, "maximum": 1438.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS ADULT", "code_information": [{"code": "D1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.99, "maximum": 140.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS CHILD", "code_information": [{"code": "D1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.75, "maximum": 94.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL RETAINR CAST METL", "code_information": [{"code": "D6545", "type": "HCPCS"}], "standard_charges": [{"minimum": 796.3, "maximum": 796.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SALIOGRAPHY", "code_information": [{"code": "D0310", "type": "HCPCS"}], "standard_charges": [{"minimum": 293.65, "maximum": 293.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 293.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SEALANT PER TOOTH", "code_information": [{"code": "D1351", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.15, "maximum": 74.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SKIN GRAFT", "code_information": [{"code": "D7920", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3670.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL SUTURE WOUND TO 5 CM", "code_information": [{"code": "D7911", "type": "HCPCS"}], "standard_charges": [{"minimum": 600.2, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 600.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL TMJ ARTHROGRAM INCL I", "code_information": [{"code": "D0320", "type": "HCPCS"}], "standard_charges": [{"minimum": 889.16, "maximum": 889.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 889.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL TOMOGRAPHIC SURVEY", "code_information": [{"code": "D0322", "type": "HCPCS"}], "standard_charges": [{"minimum": 377.06, "maximum": 377.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 377.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL UNSPEC RESTORATIVE PR", "code_information": [{"code": "D2999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MANDBL", "code_information": [{"code": "D5811", "type": "HCPCS"}], "standard_charges": [{"minimum": 1248.81, "maximum": 1248.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1248.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MAXILL", "code_information": [{"code": "D5810", "type": "HCPCS"}], "standard_charges": [{"minimum": 1248.81, "maximum": 1248.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1248.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MANDBL", "code_information": [{"code": "D5821", "type": "HCPCS"}], "standard_charges": [{"minimum": 1041.82, "maximum": 1041.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1041.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MAXILL", "code_information": [{"code": "D5820", "type": "HCPCS"}], "standard_charges": [{"minimum": 1041.82, "maximum": 1041.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1041.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND DIR", "code_information": [{"code": "D5731", "type": "HCPCS"}], "standard_charges": [{"minimum": 624.4, "maximum": 624.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 624.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND IND", "code_information": [{"code": "D5751", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX DIR", "code_information": [{"code": "D5730", "type": "HCPCS"}], "standard_charges": [{"minimum": 624.4, "maximum": 624.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 624.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX INDIR", "code_information": [{"code": "D5750", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND DIR", "code_information": [{"code": "D5741", "type": "HCPCS"}], "standard_charges": [{"minimum": 520.4, "maximum": 520.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND INDIR", "code_information": [{"code": "D5761", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX DIR", "code_information": [{"code": "D5740", "type": "HCPCS"}], "standard_charges": [{"minimum": 520.4, "maximum": 520.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 520.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX INDIR", "code_information": [{"code": "D5760", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDITN MAXILL", "code_information": [{"code": "D5850", "type": "HCPCS"}], "standard_charges": [{"minimum": 271.01, "maximum": 271.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDTIN MANDBL", "code_information": [{"code": "D5851", "type": "HCPCS"}], "standard_charges": [{"minimum": 271.01, "maximum": 271.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAND", "code_information": [{"code": "D5411", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.46, "maximum": 123.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAXIL", "code_information": [{"code": "D5410", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.46, "maximum": 123.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MANDBL", "code_information": [{"code": "D5422", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.46, "maximum": 123.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MAXILL", "code_information": [{"code": "D5421", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.46, "maximum": 123.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MANDIBLE", "code_information": [{"code": "D5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 2604.08, "maximum": 2604.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2604.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MAXILLARY", "code_information": [{"code": "D5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 2604.08, "maximum": 2604.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2604.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MANDIBLE", "code_information": [{"code": "D5140", "type": "HCPCS"}], "standard_charges": [{"minimum": 2864.17, "maximum": 2864.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2864.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MAXILLARY", "code_information": [{"code": "D5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 2864.17, "maximum": 2864.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2864.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES MAND PART RESIN", "code_information": [{"code": "D5212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1844.08, "maximum": 1844.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1844.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES MANDIBL PART METAL", "code_information": [{"code": "D5214", "type": "HCPCS"}], "standard_charges": [{"minimum": 3123.23, "maximum": 3123.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3123.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART METAL", "code_information": [{"code": "D5213", "type": "HCPCS"}], "standard_charges": [{"minimum": 3123.23, "maximum": 3123.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3123.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART RESIN", "code_information": [{"code": "D5211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1770.27, "maximum": 1770.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1770.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAND", "code_information": [{"code": "D5711", "type": "HCPCS"}], "standard_charges": [{"minimum": 1041.82, "maximum": 1041.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1041.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAXIL", "code_information": [{"code": "D5710", "type": "HCPCS"}], "standard_charges": [{"minimum": 1041.82, "maximum": 1041.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1041.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MANDBL", "code_information": [{"code": "D5721", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MAXILL", "code_information": [{"code": "D5720", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPO-ESTRADIOL CYPIONATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1000", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.61, "maximum": 135.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPRESSION SCREEN ANNUAL", "code_information": [{"code": "G0444", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1827.0, "maximum": 21578.6, "estimated_discounted_cash": 56714.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1827.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10997.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10623.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10211.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17088.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21578.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2763.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1062.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 119.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2178.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 875.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM-MAXX, PER SQ CM", "code_information": [{"code": "Q4238", "type": "HCPCS"}], "standard_charges": [{"minimum": 6030.87, "maximum": 6030.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6030.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMA-FAT-FASCIA GRAFT", "code_information": [{"code": "15770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2465.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 827.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMA-GIDE, 1 SQ CM", "code_information": [{"code": "Q4203", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.15, "maximum": 784.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 784.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1355.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1560.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 638.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1302.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 552.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2426.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1032.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMACELL, AWM, POROUS SQ CM", "code_information": [{"code": "Q4122", "type": "HCPCS"}], "standard_charges": [{"minimum": 4425.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMACYTE AMN MEM ALLO SQ CM", "code_information": [{"code": "Q4248", "type": "HCPCS"}], "standard_charges": [{"minimum": 4092.98, "maximum": 4092.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4092.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAGRAFT PER SQ CM", "code_information": [{"code": "Q4106", "type": "HCPCS"}, {"code": "8246126", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.47, "maximum": 170.47, "gross_charge": 330.0, "discounted_cash": 247.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAGRAFT PER SQ CM", "code_information": [{"code": "Q4106", "type": "HCPCS"}, {"code": "8246126", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.47, "maximum": 170.47, "gross_charge": 330.0, "discounted_cash": 247.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 248.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAPURE 1 SQUARE CM", "code_information": [{"code": "Q4152", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.23, "maximum": 191.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 191.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMAVEST, PLURIVEST SQ CM", "code_information": [{"code": "Q4153", "type": "HCPCS"}], "standard_charges": [{"minimum": 440.96, "maximum": 440.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 440.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 325.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESIGN MLC DEVICE FOR IMRT", "code_information": [{"code": "77338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1434.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1434.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 470.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1155.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1284.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 888.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 300.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303568", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303568", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303569", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303573", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESIPRAMINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303573", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .01%2.5MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330639", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1364.0, "discounted_cash": 1023.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .01%2.5MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330639", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1364.0, "discounted_cash": 1023.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .01%5ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330641", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2466.0, "discounted_cash": 1849.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .01%5ML SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330641", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2466.0, "discounted_cash": 1849.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303586", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN .2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303586", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}, {"code": "5319819", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESMOPRESSIN PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}, {"code": "5319819", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 24.0, "maximum": 24.0, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 117.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 60.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 59.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY C/TH FACET JNT ADDL", "code_information": [{"code": "64634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 243.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY CERV/THOR FACET JNT", "code_information": [{"code": "64633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 700.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 556.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 268.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY L/S FACET JNT ADDL", "code_information": [{"code": "64636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 212.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 283.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 190.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY LUMB/SAC FACET JNT", "code_information": [{"code": "64635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 701.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 261.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 261.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE FACE MUSCLE", "code_information": [{"code": "64612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 435.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 167.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 782.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 296.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 359.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS COMPLEX", "code_information": [{"code": "57065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 683.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS SIMPLE", "code_information": [{"code": "57061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 424.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 201.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION/S COMPL", "code_information": [{"code": "56515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 780.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESIONS SIM", "code_information": [{"code": "56501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 491.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 231.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT B9 LESION 1-14", "code_information": [{"code": "17110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 15 OR MORE", "code_information": [{"code": "17111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 305.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 202.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 83.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 504.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 295.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 496.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 391.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 669.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 391.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1420.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 545.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1494.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1420.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 530.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1011.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 422.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1315.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 549.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1928.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 392.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 177.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 352.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 44.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 170.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 44.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 629.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2547.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 853.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESVENLAFAXINE 50MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303590", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESVENLAFAXINE 50MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303590", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESVENLAFAXINE100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESVENLAFAXINE100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303591", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DETERMINE REFRACTIVE STATE", "code_information": [{"code": "92015", "type": "CPT"}], "standard_charges": [{"minimum": 0.72, "maximum": 69.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV CAPIO SUTURE OPEN", "code_information": [{"code": "C2631", "type": "HCPCS"}, {"code": "8240916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4934.0, "discounted_cash": 3700.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEV CLOSR VASC IMP/INSRT", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8240133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2095.0, "discounted_cash": 1571.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEV EXCHANGE TRAPPER", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "8056932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3355.0, "discounted_cash": 2516.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 132.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV REP URINARY W/SLING", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "8240135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 60140.0, "discounted_cash": 45105.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEV RETRIEVAL INSERTABLE", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "8240139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3372.0, "discounted_cash": 2529.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 452.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 452.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 207.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 207.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 67.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 42.22, "maximum": 42.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVICE HANDLING PHYS/QHP", "code_information": [{"code": "99002", "type": "CPT"}], "standard_charges": [{"minimum": 26.7, "maximum": 26.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5123.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1716.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXA AXIAL SKELETON", "code_information": [{"code": "77080", "type": "CPT"}, {"code": "4906050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 262.74, "gross_charge": 1174.0, "discounted_cash": 880.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 188.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 236.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 262.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 107.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETH/NEO/POLY 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330722", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETH/NEO/POLY 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330722", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETH/NEO/POLY3.5GMOO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330751", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETH/NEO/POLY3.5GMOO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330751", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHA OPTH INSERT 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1096", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE .1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330695", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE .1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330695", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303596", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303596", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303610", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303610", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303603", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303603", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303604", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303604", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314891", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE 5MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314891", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7637", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.38, "maximum": 0.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7638", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.8, "maximum": 0.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE INTRA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7312", "type": "HCPCS"}], "standard_charges": [{"minimum": 779.89, "maximum": 779.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 779.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 614.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 139.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 162.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 74.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 82.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 614.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 145.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE-S PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1100", "type": "HCPCS"}, {"code": "5319864", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.45, "maximum": 0.45, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LEVEL VI", "code_information": [{"code": "755T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD LVL III", "code_information": [{"code": "752T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP SLD SPC GRPI", "code_information": [{"code": "756T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DGTZ GLS MCRSCP XM ARCH TISS", "code_information": [{"code": "847T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIA-CIR APLAS+IMG+S&I", "code_information": [{"code": "4916907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4828.0, "discounted_cash": 3621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR EMBOL+IMG+S&I", "code_information": [{"code": "4916909", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4828.0, "discounted_cash": 3621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR STENT+IMG+S&I", "code_information": [{"code": "4916908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4828.0, "discounted_cash": 3621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+IMG+S&I", "code_information": [{"code": "4916904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34022.0, "discounted_cash": 25516.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+PLST+IMG+S&I", "code_information": [{"code": "4916905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 68950.0, "discounted_cash": 51712.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIA-CIR THRO+STN+IMG+S&I", "code_information": [{"code": "4916906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 110245.0, "discounted_cash": 82683.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN  PER INDIV", "code_information": [{"code": "G0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 199.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN IND/GROUP", "code_information": [{"code": "G0109", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV ONLINE/ELEC", "code_information": [{"code": "488T", "type": "CPT"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 176.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "403T", "type": "CPT"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "A4341", "type": "HCPCS"}], "standard_charges": [{"minimum": 1262.84, "maximum": 1262.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1262.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9726.46, "maximum": 20553.45, "estimated_discounted_cash": 64755.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12035.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10474.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10118.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9726.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16276.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20553.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15592.51, "maximum": 32949.28, "estimated_discounted_cash": 127156.57, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20315.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16792.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16221.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15592.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26093.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32949.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6741.88, "maximum": 14246.6, "estimated_discounted_cash": 37308.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8840.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7260.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7013.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6741.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11282.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14246.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 607.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG LAPARO SEPARATE PROC", "code_information": [{"code": "49320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "estimated_discounted_cash": 27991.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1201.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG TST DETECT MUCOS ABNORM", "code_information": [{"code": "D0431", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.87, "maximum": 96.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 340.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 452.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 150.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC CASTS", "code_information": [{"code": "D0470", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.4, "maximum": 111.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC COLONOSCOPY", "code_information": [{"code": "45378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6796.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 154.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC SIGMOIDOSCOPY", "code_information": [{"code": "45330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7990.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 224.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAL-CIRC BAL-PLASTY+S&I", "code_information": [{"code": "4926902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32475.0, "discounted_cash": 24356.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAL-CIRC STNT+PLSTY+S&I", "code_information": [{"code": "4916903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 68950.0, "discounted_cash": 51712.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSATE 1000-1999ML PD", "code_information": [{"code": "A4722", "type": "HCPCS"}, {"code": "5412084", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 308.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSATE 2000-2999ML PD", "code_information": [{"code": "A4722", "type": "HCPCS"}, {"code": "5412078", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSATE 3000-3999ML PD", "code_information": [{"code": "A4723", "type": "HCPCS"}, {"code": "5412079", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 291.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSATE 5000-5999ML PD", "code_information": [{"code": "A4725", "type": "HCPCS"}, {"code": "5412082", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSIS BLOOD PRESSURE CUFF", "code_information": [{"code": "A4663", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.75, "maximum": 61.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 711.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1732.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2144.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1732.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS EQUIPMENT NOC", "code_information": [{"code": "E1699", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 443.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 443.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING COMPLETE", "code_information": [{"code": "90989", "type": "CPT"}], "standard_charges": [{"minimum": 1522.66, "maximum": 1522.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1522.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 331.74, "maximum": 331.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 331.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIALYZER, EACH", "code_information": [{"code": "A4690", "type": "HCPCS"}], "standard_charges": [{"minimum": 1583.92, "maximum": 1583.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1583.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAPER SERV REUSABLE DIAPER", "code_information": [{"code": "T4538", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIATR MEGNASOL66/10 120M", "code_information": [{"code": "5355480", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 661.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303708", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303708", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 5 MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314931", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 5 MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314931", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303712", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303712", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM UPTO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "5327420", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 20.73, "maximum": 20.73, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM UPTO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "5327420", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 20.73, "maximum": 20.73, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZOXIDE 100MG/2ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314936", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZOXIDE 100MG/2ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314936", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 75.0, "discounted_cash": 56.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1730", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.89, "maximum": 490.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 490.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIBUCAINE NUMBER", "code_information": [{"code": "82638", "type": "CPT"}, {"code": "7252638", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.46, "gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.78, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC .1% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330761", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC .1% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330761", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC .1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 597.0, "discounted_cash": 447.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC .1% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 597.0, "discounted_cash": 447.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC 1% 100GM GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1151.0, "discounted_cash": 863.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICLOFENAC 1% 100GM GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335212", "type": "CDM"}, {"code": "637", "type": 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"CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303820", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303820", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303824", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303824", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE UPTO 20MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0500", "type": "HCPCS"}, {"code": "5319981", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 94.69, "maximum": 94.69, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE UPTO 20MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0500", "type": "HCPCS"}, {"code": "5319981", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 94.69, "maximum": 94.69, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIDANOSINE, 25 MG", "code_information": [{"code": "S0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.86, "maximum": 1.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIETHYLSTILBESTROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9165", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.36, "maximum": 48.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFELIKEFALIN, ESRD ON DIALY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0879", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.83, "maximum": 0.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFFUSING CAPACITY", "code_information": [{"code": "94729", "type": "CPT"}, {"code": "5504729", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 174.21, "gross_charge": 1615.0, "discounted_cash": 1211.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 57.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFLUNISAL 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303894", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFLUNISAL 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5303894", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIG BREAST TOMO UNI", "code_information": [{"code": "77061", "type": "CPT"}, {"code": "4907061", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 91.42, "maximum": 618.37, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 618.37, "methodology": "fee 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"MS-DRG"}], "standard_charges": [{"minimum": 13127.79, "maximum": 27740.97, "estimated_discounted_cash": 60499.11, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18107.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14137.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13657.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13127.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21968.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27740.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23211.31, "maximum": 49048.95, "estimated_discounted_cash": 140321.54, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29403.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24997.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24148.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23211.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38843.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49048.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10031.43, "maximum": 21197.9, "estimated_discounted_cash": 60027.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13142.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10803.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10436.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 647.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGITAL SUB 2 OR MORE IMAGES", "code_information": [{"code": "D0394", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.19, "maximum": 82.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGITOXIN", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "7250242", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.7, "gross_charge": 462.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charges": [{"minimum": 35.68, "maximum": 35.68, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN.05MG/ML 2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314966", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN.05MG/ML 2.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5314966", 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"J1110", "type": "HCPCS"}, {"code": "5320049", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 160.6, "maximum": 160.6, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}], "standard_charges": [{"minimum": 26.35, "maximum": 111.06, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 29.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 32.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIL BLLN ESOPH WR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8174028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1778.0, "discounted_cash": 1333.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT BILE DUCT EA", "code_information": [{"code": "4917542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11347.0, "discounted_cash": 8510.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": 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"plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", 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"UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 534.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 885.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 303.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 480.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 373.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 373.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 313.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 737.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 737.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS 1/MULT PASS", "code_information": [{"code": "43450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 113.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1709.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 115.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 108.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 192.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 77.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 259.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 194.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION AND CURETTAGE", "code_information": [{"code": "58120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 857.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 361.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF ANAL SPHINCTER", "code_information": [{"code": "45905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 623.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF CERVICAL CANAL", "code_information": [{"code": "57800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF RECTAL NARROWING", "code_information": [{"code": "45910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 706.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 45.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1792.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILTIAZEM 120MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304039", "type": "CDM"}, {"code": "250", 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"discounted_cash": 5229.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYD-ZINC 2% 30GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335269", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYD-ZINC 2% 30GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335269", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDR UPTO 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1200", "type": "HCPCS"}, {"code": "5320117", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.05, "maximum": 3.05, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDR UPTO 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1200", "type": "HCPCS"}, {"code": "5320117", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.05, "maximum": 3.05, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRA 2.5MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRA 2.5MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315006", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRA12.5/5 10 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRA12.5/5 10 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315001", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 25MG CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304087", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE 25MG CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304087", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE HCL 50MG", "code_information": [{"code": "Q0163", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.06, "maximum": 1.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENOX/ATROP 2.5 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304098", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENOX/ATROP 2.5 TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304098", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENOXYLATE/ATRP 5 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315015", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENOXYLATE/ATRP 5 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315015", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHER TET <7YR IJ", "code_information": [{"code": "90702", "type": "CPT"}, {"code": "5320139", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 284.7, "maximum": 284.7, "gross_charge": 500.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 284.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHER TET <7YR IJ", "code_information": [{"code": "90702", "type": "CPT"}, {"code": "5320139", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 284.7, "maximum": 284.7, "gross_charge": 500.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 284.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHER TET >7YR PF IJ", "code_information": [{"code": "90714", "type": "CPT"}, {"code": "5320137", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 115.09, "maximum": 115.09, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHER TET >7YR PF IJ", "code_information": [{"code": "90714", "type": "CPT"}, {"code": "5320137", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 115.09, "maximum": 115.09, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTIBODY", "code_information": [{"code": "86648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.54, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRDAML/ASA200/25 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304123", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRDAML/ASA200/25 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304123", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304114", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304122", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304122", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE PER10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1245", "type": "HCPCS"}, {"code": "5320170", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.1, "maximum": 14.1, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE PER10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1245", "type": "HCPCS"}, {"code": "5320170", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.1, "maximum": 14.1, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 106.55, "maximum": 106.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIS SITE TELE SVCS RHC/FQHC", "code_information": [{"code": "G2025", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.37, "maximum": 355.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 355.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHO SEC CLSR", "code_information": [{"code": "23921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1751.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 588.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4109.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1380.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISC CERVICAL ARTIFICL MOBI-C", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4011998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61956.0, "discounted_cash": 46467.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISCOGRAPHY CERV/THOR SPINE", "code_information": [{"code": "72285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1754.39, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 87.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 433.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 481.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 92.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISCOGRAPHY LUMBAR", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "4912290", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1754.39, "gross_charge": 5266.0, "discounted_cash": 3949.5, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 90.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 423.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 470.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 262.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1754.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISE EVAL SLP DO BRTH FLX DX", "code_information": [{"code": "42975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 16119.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2351", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304143", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISOPYRAMIDE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304143", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "442", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10476.4, "maximum": 22138.19, "estimated_discounted_cash": 59708.19, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13499.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11282.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10899.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10476.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17531.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22138.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "441", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19477.88, "maximum": 41159.65, "estimated_discounted_cash": 149725.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27440.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20976.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20263.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19477.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32595.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41159.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "443", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7593.84, "maximum": 16046.92, "estimated_discounted_cash": 65932.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9487.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8178.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7900.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7593.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12707.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16046.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [{"code": "439", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9129.54, "maximum": 19292.08, "estimated_discounted_cash": 83894.69, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13215.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9831.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9497.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9129.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15277.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19292.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17692.56, "maximum": 37387.01, "estimated_discounted_cash": 153862.33, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24800.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19053.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18406.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17692.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29607.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37387.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "440", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6744.05, "maximum": 14251.19, "estimated_discounted_cash": 53819.46, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9357.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7262.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7016.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6744.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11285.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14251.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [{"code": "883", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1827.0, "maximum": 45095.12, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1827.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22982.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22201.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21340.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35711.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45095.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [{"code": "445", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11877.52, "maximum": 25098.97, "estimated_discounted_cash": 54851.93, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15521.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12791.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12356.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11877.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19876.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25098.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18134.28, "maximum": 38320.42, "estimated_discounted_cash": 98531.11, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23619.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19529.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18866.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18134.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30346.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38320.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8978.69, "maximum": 18973.3, "estimated_discounted_cash": 84590.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11027.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9669.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9341.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8978.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15025.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18973.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL BINAU", "code_information": [{"code": "V5240", "type": "HCPCS"}], "standard_charges": [{"minimum": 945.75, "maximum": 945.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL MONAU", "code_information": [{"code": "V5200", "type": "HCPCS"}], "standard_charges": [{"minimum": 913.05, "maximum": 913.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 913.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/30 DAYS", "code_information": [{"code": "Q0513", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.17, "maximum": 125.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISP FEE INHAL DRUGS/90 DAYS", "code_information": [{"code": "Q0514", "type": "HCPCS"}], "standard_charges": [{"minimum": 250.34, "maximum": 250.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISPENS FEE IMMUNOSUPRESSIVE", "code_information": [{"code": "Q0510", "type": "HCPCS"}], "standard_charges": [{"minimum": 189.65, "maximum": 189.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 189.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISPENSE FEE INITIAL 30 DAY", "code_information": [{"code": "G0333", "type": "HCPCS"}], "standard_charges": [{"minimum": 216.2, "maximum": 216.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE BINAURAL", "code_information": [{"code": "V5160", "type": "HCPCS"}], "standard_charges": [{"minimum": 1103.16, "maximum": 1103.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1103.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE, MONAURAL", "code_information": [{"code": "V5241", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE LINER/SHIELD/PAD", "code_information": [{"code": "T4535", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISPOSABLE UNDERPADS", "code_information": [{"code": "A4554", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5574.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1864.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1327.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1327.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92977", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 198.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 67.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 44390.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4030.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1347.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISTANCE LEARNING ATTENDANCE", "code_information": [{"code": "G9887", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.83, "maximum": 94.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISULFIRAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304178", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISULFIRAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304178", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304190", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 125MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304191", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304196", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 250MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304196", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304193", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304193", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304195", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVALPROX NA 500MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304195", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1363.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 452.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1239.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 411.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2813.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 939.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1035.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1058.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 200.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4034", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.88, "maximum": 13.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.78, "maximum": 23.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4036", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.7, "maximum": 18.7, "setting": "outpatient", 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"code_information": [{"code": "A4402", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.27, "maximum": 8.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4404", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.93, "maximum": 7.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4405", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.68, "maximum": 17.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}], "billing_class": 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"code_information": [{"code": "A4408", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.09, "maximum": 51.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4409", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.13, "maximum": 32.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4410", "type": 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"maximum": 1.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4541", "type": "HCPCS"}], "standard_charges": [{"minimum": 146.71, "maximum": 146.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4542", "type": "HCPCS"}], "standard_charges": [{"minimum": 1913.23, "maximum": 1913.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1913.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4556", "type": 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"code_information": [{"code": "A6210", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.13, "maximum": 103.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6211", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.02, "maximum": 152.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6214", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.29, "maximum": 53.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6216", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6217", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6219", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.93, "maximum": 4.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.93, 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[{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6232", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.54, "maximum": 35.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.54, "methodology": "fee schedule"}], "billing_class": 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"code_information": [{"code": "A6235", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.05, "maximum": 87.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6236", "type": "HCPCS"}], "standard_charges": [{"minimum": 141.02, "maximum": 141.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6237", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.93, "maximum": 40.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6241", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.31, "maximum": 13.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6242", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.33, "maximum": 31.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6243", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.8, "maximum": 63.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6247", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.08, "maximum": 123.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6248", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.09, "maximum": 84.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6251", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.28, "maximum": 10.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6252", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.84, "maximum": 16.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6253", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.77, "maximum": 32.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6254", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.18, "maximum": 6.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6255", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.74, "maximum": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6257", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.93, "maximum": 7.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6258", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.3, "maximum": 22.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6259", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.59, "maximum": 56.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6266", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.9, "maximum": 9.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6402", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6403", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.12, "maximum": 2.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6407", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.67, "maximum": 9.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6410", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.93, "maximum": 1.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6411", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6441", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.53, "maximum": 3.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.53, "methodology": 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"standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6444", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.88, "maximum": 2.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6445", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.63, "maximum": 1.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6446", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.01, "maximum": 2.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.01, "methodology": 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"standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6449", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.07, "maximum": 9.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6450", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.07, "maximum": 9.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6451", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.07, "maximum": 9.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.07, "methodology": 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"standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6454", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.06, "maximum": 4.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6455", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.21, "maximum": 7.21, 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1374.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6525", "type": "HCPCS"}], "standard_charges": [{"minimum": 2774.96, "maximum": 2774.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2774.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6526", "type": "HCPCS"}], "standard_charges": [{"minimum": 2485.1, "maximum": 2485.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2485.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6527", "type": "HCPCS"}], "standard_charges": 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"code_information": [{"code": "A6530", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.08, "maximum": 140.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6531", "type": "HCPCS"}], "standard_charges": [{"minimum": 223.9, "maximum": 223.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 223.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6532", "type": "HCPCS"}], "standard_charges": [{"minimum": 315.5, "maximum": 315.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 315.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6533", "type": "HCPCS"}], "standard_charges": [{"minimum": 196.7, "maximum": 196.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 196.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6534", "type": "HCPCS"}], "standard_charges": [{"minimum": 224.62, "maximum": 224.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 224.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6535", "type": "HCPCS"}], "standard_charges": [{"minimum": 258.61, "maximum": 258.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6536", "type": "HCPCS"}], "standard_charges": [{"minimum": 265.17, "maximum": 265.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 265.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6537", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.36, "maximum": 314.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.36, "methodology": "fee 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{"description": "DME POS", "code_information": [{"code": "A6540", "type": "HCPCS"}], "standard_charges": [{"minimum": 418.37, "maximum": 418.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 418.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6541", "type": "HCPCS"}], "standard_charges": [{"minimum": 495.59, "maximum": 495.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 495.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6545", "type": "HCPCS"}], "standard_charges": [{"minimum": 440.9, "maximum": 440.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 440.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6550", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.42, "maximum": 112.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6552", "type": "HCPCS"}], "standard_charges": [{"minimum": 207.89, "maximum": 207.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 207.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6553", "type": "HCPCS"}], "standard_charges": [{"minimum": 811.74, "maximum": 811.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 811.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6554", "type": "HCPCS"}], "standard_charges": [{"minimum": 285.84, "maximum": 285.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 285.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6555", "type": "HCPCS"}], "standard_charges": [{"minimum": 811.74, "maximum": 811.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 811.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6556", "type": "HCPCS"}], "standard_charges": [{"minimum": 1112.45, "maximum": 1112.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1112.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6557", "type": "HCPCS"}], "standard_charges": [{"minimum": 1112.45, "maximum": 1112.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1112.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6558", "type": "HCPCS"}], "standard_charges": [{"minimum": 1148.03, "maximum": 1148.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1148.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6562", "type": "HCPCS"}], "standard_charges": [{"minimum": 3640.82, "maximum": 3640.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3640.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6563", "type": "HCPCS"}], "standard_charges": [{"minimum": 3640.82, "maximum": 3640.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3640.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6564", "type": "HCPCS"}], "standard_charges": [{"minimum": 3921.96, "maximum": 3921.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3921.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A6565", "type": "HCPCS"}], "standard_charges": [{"minimum": 629.11, "maximum": 629.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 629.11, 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{"description": "DME POS", "code_information": [{"code": "L0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 1981.54, "maximum": 1981.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1981.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0200", "type": "HCPCS"}], "standard_charges": [{"minimum": 2873.31, "maximum": 2873.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2873.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 511.07, "maximum": 511.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4038", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.56, "maximum": 190.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "Q4039", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.12, "maximum": 38.12, "setting": "outpatient", "payers_information": 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"standard_charges": [{"minimum": 371.68, "maximum": 371.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 371.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2100", "type": "HCPCS"}], "standard_charges": [{"minimum": 174.17, "maximum": 174.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2101", "type": "HCPCS"}], "standard_charges": [{"minimum": 233.46, "maximum": 233.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2102", "type": "HCPCS"}], "standard_charges": [{"minimum": 283.15, "maximum": 283.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 283.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2103", "type": "HCPCS"}], "standard_charges": [{"minimum": 166.29, "maximum": 166.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2104", "type": "HCPCS"}], "standard_charges": [{"minimum": 175.92, "maximum": 175.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2105", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.91, "maximum": 192.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 192.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2106", "type": "HCPCS"}], "standard_charges": [{"minimum": 230.8, "maximum": 230.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2107", "type": "HCPCS"}], "standard_charges": [{"minimum": 248.44, "maximum": 248.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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278.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2114", "type": "HCPCS"}], "standard_charges": [{"minimum": 302.19, "maximum": 302.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 421.06, "maximum": 421.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 421.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 420.3, "maximum": 420.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2121", "type": "HCPCS"}], "standard_charges": [{"minimum": 448.79, "maximum": 448.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 448.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "V2200", "type": "HCPCS"}], "standard_charges": [{"minimum": 260.28, "maximum": 260.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DME POS", 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"DOBUTAMN PER250MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}, {"code": "5320186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 37.35, "maximum": 37.35, "gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOBUTAMN PER250MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}, {"code": "5320186", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 37.35, "maximum": 37.35, "gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9171", "type": "HCPCS"}, {"code": "5320194", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.77, "maximum": 3.77, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9171", "type": "HCPCS"}, {"code": "5320194", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.77, "maximum": 3.77, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCOSANOL 10% 2GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335290", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCOSANOL 10% 2GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335290", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE 100MG CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304219", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE 100MG CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304219", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE 100MG/10ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315054", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE 100MG/10ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315054", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE NA RE", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338333", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE NA RE", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5338333", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE/SENNA TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310756", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOCUSATE/SENNA TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310756", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOFETILDE .125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304230", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304230", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304231", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOFETILDE .5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON 50 MG", "code_information": [{"code": "S0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.45, "maximum": 140.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1260", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.4, "maximum": 23.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE ORAL", "code_information": [{"code": "Q0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.0, "maximum": 384.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLUTEGRAVIR 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304257", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 590.0, "discounted_cash": 442.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLUTEGRAVIR 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304257", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 590.0, "discounted_cash": 442.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOME PATELLA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9036.0, "discounted_cash": 6777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME TALAR CHAMFER-CUT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8131566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 70268.0, "discounted_cash": 52701.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONEPEZIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONEPEZIL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304250", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR LOBECTOMY (LUNG)", "code_information": [{"code": "S2061", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 2172.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DONOR SERV IVF CASE RATE", "code_information": [{"code": "S4025", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPAMINE PER40MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1265", "type": "HCPCS"}, {"code": "5320208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.93, "maximum": 2.93, "gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPAMINE PER40MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1265", "type": "HCPCS"}, {"code": "5320208", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.93, "maximum": 2.93, "gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT ADDL", "code_information": [{"code": "93572", "type": "CPT"}, {"code": "4613658", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21885.0, "gross_charge": 29180.0, "discounted_cash": 21885.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 18967.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 11672.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 21885.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT ADDL", "code_information": [{"code": "93572", "type": "CPT"}, {"code": "4613658", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21885.0, "gross_charge": 29180.0, "discounted_cash": 21885.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 18967.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 11672.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 21885.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT INIT", "code_information": [{"code": "93571", "type": "CPT"}, {"code": "4613657", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21708.0, "gross_charge": 28944.0, "discounted_cash": 21708.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 18813.6, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 11577.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 762.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 21708.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPP FLW/PR MSMNT INIT", "code_information": [{"code": "93571", "type": "CPT"}, {"code": "4613657", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21708.0, "gross_charge": 28944.0, "discounted_cash": 21708.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 18813.6, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 11577.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 762.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 21708.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO COLOR FLOW", "code_information": [{"code": "93325", "type": "CPT"}, {"code": "4603330", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.89, "gross_charge": 2106.0, "discounted_cash": 1579.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO PULSE/CONT", "code_information": [{"code": "93320", "type": "CPT"}, {"code": "4603325", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 120.96, "gross_charge": 2062.0, "discounted_cash": 1546.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORAVIRINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304300", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 341.0, "discounted_cash": 255.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORAVIRINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304300", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 341.0, "discounted_cash": 255.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORIPENEM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1267", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.34, "maximum": 3.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALF2.5MG/2.5MLIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5330780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 814.0, "discounted_cash": 610.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALF2.5MG/2.5MLIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5330780", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 814.0, "discounted_cash": 610.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALFA NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7639", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.53, "maximum": 197.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORZOLAMIDE 2% 10ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330786", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORZOLAMIDE 2% 10ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330786", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13832.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13832.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4625.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOXAZOSIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXAZOSIN 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304335", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXAZOSIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304336", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXAZOSIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304336", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304371", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304371", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304342", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304342", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315091", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 10MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315091", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304365", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304365", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304367", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXEPIN 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304367", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXERCALCIFERL PER1MCGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1270", "type": "HCPCS"}, {"code": "5320252", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1.43, "maximum": 1.43, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXERCALCIFERL PER1MCGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1270", "type": "HCPCS"}, {"code": "5320252", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.43, "maximum": 1.43, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN INJ 10MG", "code_information": [{"code": "Q2050", "type": "HCPCS"}], "standard_charges": [{"minimum": 324.24, "maximum": 324.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 324.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9000", "type": "HCPCS"}, {"code": "5320268", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 12.44, "maximum": 12.44, "gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9000", "type": "HCPCS"}, {"code": "5320268", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.44, "maximum": 12.44, "gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304388", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE 50MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304388", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE HYCLATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1271", "type": "HCPCS"}, {"code": "5320295", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.4, "discounted_cash": 0.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYCYCLINE HYCLATE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1271", "type": "HCPCS"}, {"code": "5320295", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.4, "discounted_cash": 0.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYLAMINE 25MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DOXYLAMINE 25MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5304385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 663.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 175.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2849.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 954.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN BL W/CATH INSERTION", "code_information": [{"code": "51102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 21580.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 514.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 184.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLOOD FROM UNDER NAIL", "code_information": [{"code": "11740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 840.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1849.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 620.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4394.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 461.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 63.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 223.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 63.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 593.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN HAND TENDON SHEATH", "code_information": [{"code": "26020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2061.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 694.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG BURSA", "code_information": [{"code": "27604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1190.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 131.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 131.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG LESION", "code_information": [{"code": "27603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 27747.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1433.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 633.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN NECK/CHEST LESION", "code_information": [{"code": "21501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1241.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 594.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3637.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4092.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1370.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3967.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1341.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1248.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2619.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 870.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3980.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1333.29, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1111.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 371.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2496.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 842.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 819.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 218.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 218.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER LESION", "code_information": [{"code": "23030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 936.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 192.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 531.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 192.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1191.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 399.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN THIGH/KNEE LESION", "code_information": [{"code": "27301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1874.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 822.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 228.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2797.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 937.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1445.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/O US", "code_information": [{"code": "20610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1755.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 188.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 5727.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 214.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5775.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5775.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1933.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 768.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 133.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 408.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 133.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1811.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 608.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 401.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6799.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6799.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2276.71, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1499.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 503.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1652.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3704.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1232.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2365.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 795.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BURSA OF FOOT", "code_information": [{"code": "28001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 206.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 144.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1684.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 560.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1728.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 422.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1793.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 521.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 211.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 405.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 211.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER ABSCESS", "code_information": [{"code": "26011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4394.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 682.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 303.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 566.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 303.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1374.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM LESION", "code_information": [{"code": "25028", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2543.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 838.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GLAND ABSCESS", "code_information": [{"code": "56420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1741.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 406.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 223.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 835.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3427.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1150.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": "55000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 308.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 435.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 728.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 112.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 416.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 112.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 811.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 486.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1046.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1094.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1260.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1253.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1461.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1161.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 439.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1575.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSA", "code_information": [{"code": "26025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1555.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 522.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSAS", "code_information": [{"code": "26030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1822.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 613.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1570.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 525.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "57010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1683.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 558.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC FLUID", "code_information": [{"code": "57020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 287.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS BURSA", "code_information": [{"code": "26991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1944.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 188.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 853.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 188.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS LESION", "code_information": [{"code": "26990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2503.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1618.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 543.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1654.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 554.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2179.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 731.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 4394.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 604.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 385.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2076.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 857.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 170.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 475.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 170.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1595.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 495.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 208.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 659.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 315.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM", "code_information": [{"code": "54700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 779.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 262.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM ABSCESS", "code_information": [{"code": "55100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 616.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5166.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1732.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6305.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2110.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1410.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 545.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2926.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 979.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF TONSIL ABSCESS", "code_information": [{"code": "42700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 500.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1436.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 482.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 607.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 231.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1541.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2364.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 793.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOUS DEVICE", "code_information": [{"code": "36591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 478.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN M", "code_information": [{"code": "16025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 405.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 189.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN S", "code_information": [{"code": "16020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1873.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRGSCRN DIR OPT INST", "code_information": [{"code": "80306", "type": "CPT"}, {"code": "4170059", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.01, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 25.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 28.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRGSCRN DIRECT OPT OBS", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "4170057", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.79, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR DRAINAGE", "code_information": [{"code": "61108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3325.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1124.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327430", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG ORAL", "code_information": [{"code": "Q0167", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.08, "maximum": 3.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONABINOL 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONABINOL 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327431", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONEDARONE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRONEDARONE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL UPTO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1790", "type": "HCPCS"}, {"code": "5320305", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 29.7, "maximum": 29.7, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL UPTO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1790", "type": "HCPCS"}, {"code": "5320305", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.7, "maximum": 29.7, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL/FENTANYL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1810", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.12, "maximum": 16.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRS DERMAL TEMPLT FEN", "code_information": [{"code": "A6021", "type": "HCPCS"}, {"code": "8024411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 108.82, "maximum": 301.0, "gross_charge": 301.0, "discounted_cash": 225.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 301.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRS FOAM HVY DRNG", "code_information": [{"code": "A6212", "type": "HCPCS"}, {"code": "8024413", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 50.26, "maximum": 50.26, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRS HYDROCOLLOID >16 <48", "code_information": [{"code": "A6238", "type": "HCPCS"}, {"code": "8024534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 118.0, "maximum": 118.0, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRS INTERCEED", "code_information": [{"code": "C1765", "type": "HCPCS"}, {"code": "8024553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3278.0, "discounted_cash": 2458.5, "setting": "both", 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"CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 442.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 499.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 254.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 609.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 298.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 735.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 431.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 219.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 497.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M2.1-3", "code_information": [{"code": "17283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 621.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 77.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 296.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 77.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 722.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 337.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 981.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 435.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ EXTENSIVE RETINOPATHY", "code_information": [{"code": "67227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 921.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 356.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 319.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 0.5 CM/<", "code_information": [{"code": "17260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 75.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 75.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 3.1-4.0", "code_information": [{"code": "17264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 252.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L >4.0 CM", "code_information": [{"code": "17266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 558.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 675.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "420T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1688.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ NULYT AGT GNCLR NRV", "code_information": [{"code": "64624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 532.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 463.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3758.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP VACCINE < 7 YRS IM", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"minimum": 115.27, "maximum": 115.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-HIB-IP VACCINE IJ", "code_information": [{"code": "90698", "type": "CPT"}, {"code": "5320136", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 498.13, "maximum": 498.13, "gross_charge": 485.0, "discounted_cash": 363.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 498.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-HIB-IP VACCINE IJ", "code_information": [{"code": "90698", "type": "CPT"}, {"code": "5320136", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 498.13, "maximum": 498.13, "gross_charge": 485.0, "discounted_cash": 363.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 498.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV VACCINE 4-6 YRS IM", "code_information": [{"code": "90696", "type": "CPT"}], "standard_charges": [{"minimum": 286.98, "maximum": 286.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 286.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 486.53, "maximum": 486.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 486.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP/HEP B/IPV VAC.5MLIJ", "code_information": [{"code": "90723", "type": "CPT"}, {"code": "5320313", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 428.38, "maximum": 428.38, "gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DTAP/HEP B/IPV VAC.5MLIJ", "code_information": [{"code": "90723", "type": "CPT"}, {"code": "5320313", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 428.38, "maximum": 428.38, "gross_charge": 553.0, "discounted_cash": 414.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUAL LAYER IMPAX, PER SQ CM", "code_information": [{"code": "Q4262", "type": "HCPCS"}], "standard_charges": [{"minimum": 4441.44, "maximum": 4441.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4441.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304410", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304410", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304411", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304411", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304412", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DULOXETINE 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304412", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6474.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6474.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2168.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 372.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 122.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUPLEX CAROTID BI/COMP", "code_information": [{"code": "93880", "type": "CPT"}, {"code": "5066541", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 554.16, "gross_charge": 4913.0, "discounted_cash": 3684.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 554.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 181.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUPLEX CAROTID UNI/LTD", "code_information": [{"code": "93882", "type": "CPT"}, {"code": "5066540", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 367.81, "gross_charge": 3850.0, "discounted_cash": 2887.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 367.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DURABLE MEDICAL EQUIPMENT MI", "code_information": [{"code": "E1399", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC ANEURYSM NECK RECONSTRUCT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8174147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 101137.0, "discounted_cash": 75852.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATHER ROTAPRO ROTAT W/BURR", "code_information": [{"code": "C1724", "type": "HCPCS"}, {"code": "8058297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18020.0, "discounted_cash": 13515.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATHERECT DIRECTIONAL", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "8058301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50571.0, "discounted_cash": 37928.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATHERECT DIRECTONAL", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "8058300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50571.0, "discounted_cash": 37928.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATHERET DIRECTIONAL", "code_information": [{"code": "C1714", "type": "HCPCS"}, {"code": "8058298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 34541.0, "discounted_cash": 25905.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATRICLIP FLEX V EXCLUSION", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8195409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19103.0, "discounted_cash": 14327.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATRICLIP LAA EXCULSN", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8192019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11922.0, "discounted_cash": 8941.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ATRICLIP PRO*V LAA EXCLUSN", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8195408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19103.0, "discounted_cash": 14327.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC BILIARY DILATN BLLN", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "8182298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2059.0, "discounted_cash": 1544.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC CLOSURE MANTA", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8174152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10076.0, "discounted_cash": 7557.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC EMBOLIC PROTECTION", "code_information": [{"code": "C1884", "type": "HCPCS"}, {"code": "8174014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12391.0, "discounted_cash": 9293.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC EMBOLIZ MSH PIPELINE", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "8174018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144304.0, "discounted_cash": 108228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ENDOBUTTON CL ULTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3348.0, "discounted_cash": 2511.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC ENDOLUMINL FRED 21 FLW DIR", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8060304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136259.0, "discounted_cash": 102194.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC FIX FASTNER ZIPTIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7206.0, "discounted_cash": 5404.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC FIXATION ADJUSTABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17850.0, "discounted_cash": 13387.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC FUSION INTERMEDULARY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9294.0, "discounted_cash": 6970.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC FX ANKL SYN ZIP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6388.0, "discounted_cash": 4791.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC FX SYNDESMOSIS SYNCH GRVTY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9820.0, "discounted_cash": 7365.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC HEMOSTAT ENDO HEMOSPRAY", "code_information": [{"code": "C1052", "type": "HCPCS"}, {"code": "8031981", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16025.0, "discounted_cash": 12018.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC INTERSPIN PROCESS CLUTCH", "code_information": [{"code": "C1821", "type": "HCPCS"}, {"code": "4013112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7631.0, "discounted_cash": 5723.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC LORDOTC INTG INTRBDY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28398.0, "discounted_cash": 21298.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC MENISCAL CINCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4212.0, "discounted_cash": 3159.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC REP URN SLING DESARA", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4021027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 10935.0, "discounted_cash": 8201.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC RETRVL FOREIGN BODY", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "8240997", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17419.0, "discounted_cash": 13064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC RETRVL MINI SNARE", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "4031886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4662.0, "discounted_cash": 3496.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC REVAS TIGERTRIEVR", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8174114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67118.0, "discounted_cash": 50338.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC REVASCULARIZATION", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8174141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67376.0, "discounted_cash": 50532.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC REVASCULARIZATION", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8174148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 63109.0, "discounted_cash": 47331.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC REVASCULARIZATION 3D", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8174146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49602.0, "discounted_cash": 37201.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC STNT INTRALUM SUPPRT LVISJ", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8060303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74863.0, "discounted_cash": 56147.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC SUTURE DELIVERY", "code_information": [{"code": "C2631", "type": "HCPCS"}, {"code": "8192026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3037.0, "discounted_cash": 2277.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC THROMB/EMB", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "4031900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.0, "discounted_cash": 761.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC TISS LOCALZTN/EXCSN", "code_information": [{"code": "C1819", "type": "HCPCS"}, {"code": "8241819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 5163.0, "discounted_cash": 3872.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC TRICLIP ABBOTT G4", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8141327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 506071.0, "discounted_cash": 379553.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC TROCHANTER FIX W CBL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8131571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 40264.0, "discounted_cash": 30198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC TRUNION ECLIPSE SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4011115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45567.0, "discounted_cash": 34175.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC UROLIFT SYS DELIVERY", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8174022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11101.0, "discounted_cash": 8325.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DVC VAS CLSR MYNX", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8174113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1858.0, "discounted_cash": 1393.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC VASCULAR CLOSURE MANTA", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8174149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9241.0, "discounted_cash": 6930.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC VERTEBRAL BODY REPLC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21195.0, "discounted_cash": 15896.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DVC WATCHMAN FLX PRO", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8174153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 191000.0, "discounted_cash": 143250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR 1ST", "code_information": [{"code": "92622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 290.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX ALY AUD OI SND PRCSR EACH", "code_information": [{"code": "92623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASP/BX MULTI", "code_information": [{"code": "4910364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5003.0, "discounted_cash": 3752.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASP/BX MULTI", "code_information": [{"code": "5050364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5404.0, "discounted_cash": 4053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATION(S)", "code_information": [{"code": "4911990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5306.0, "discounted_cash": 3979.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATION(S)", "code_information": [{"code": "5058222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW ASPIRATIONS", "code_information": [{"code": "38220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 5003.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 243.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "4918221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4605.0, "discounted_cash": 3453.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "5058221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4974.0, "discounted_cash": 3730.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW BIOPSIES", "code_information": [{"code": "38221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4563.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4735.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 211.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCH W/ NAVIGATION", "code_information": [{"code": "C7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUSH", "code_information": [{"code": "31623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 473.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 479.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 310.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/WASH", "code_information": [{"code": "31622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 13632.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 135.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 234.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 234.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 306.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 431.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 306.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPEC", "code_information": [{"code": "43754", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 137.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX I-131 SOD PER UCI", "code_information": [{"code": "A9531", "type": "HCPCS"}, {"code": "5199531", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 36.37, "maximum": 36.37, "gross_charge": 486.0, "discounted_cash": 364.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX I131 SOD CAP PER MCI", "code_information": [{"code": "A9528", "type": "HCPCS"}, {"code": "5199603", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 177.47, "maximum": 177.47, "gross_charge": 955.0, "discounted_cash": 716.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 177.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX I131 SOD SOLTN PR MCI", "code_information": [{"code": "A9529", "type": "HCPCS"}, {"code": "5199529", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 413.44, "maximum": 413.44, "gross_charge": 161.0, "discounted_cash": 120.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 413.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPCAR US CHD I&R", "code_information": [{"code": "76989", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 127.67, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP EPICAR CAR US CHD", "code_information": [{"code": "76987", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 342.28, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 342.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX INTRAOP THORACIC AORTA US", "code_information": [{"code": "76984", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 111.63, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY EXCL NB", "code_information": [{"code": "31525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 302.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 568.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 190.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY W/OPER SCOPE", "code_information": [{"code": "31526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 570.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR", "code_information": [{"code": "62270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4212.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LMBR SPI PNXR W/FLUOR/CT", "code_information": [{"code": "62328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 307.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD BILAT", "code_information": [{"code": "77066", "type": "CPT"}, {"code": "4900204", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 449.25, "gross_charge": 1566.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 263.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 404.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 449.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 406.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 135.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 116.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX MAMMO+CAD UNILAT", "code_information": [{"code": "77065", "type": "CPT"}, {"code": "4900206", "type": "CDM"}, {"code": "401", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 351.08, "gross_charge": 1236.0, "discounted_cash": 927.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 211.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 315.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 351.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX NTROP EPCR US CHD IMG ACQ", "code_information": [{"code": "76988", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 217.79, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 217.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 158.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 158.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 68.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 97.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 75.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 79.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 88.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", 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"type": "HCPCS"}], "standard_charges": [{"minimum": 295.17, "maximum": 295.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR AND THROAT EXAMINATION", "code_information": [{"code": "92502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 348.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR CARTILAGE GRAFT", "code_information": [{"code": "21235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2095.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 898.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR MICROSCOPY EXAMINATION", "code_information": [{"code": "92504", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR MOLD", "code_information": [{"code": "V5264", "type": "HCPCS"}, {"code": "8122940", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 279.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR TUBE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8121065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 428.0, "discounted_cash": 321.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13799.59, "maximum": 29160.58, "estimated_discounted_cash": 22111.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18748.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14861.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14356.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13799.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23092.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29160.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [{"code": "146", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22980.14, "maximum": 48560.45, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28772.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24748.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23907.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22980.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38456.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48560.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8650.93, "maximum": 18280.69, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11953.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9316.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9000.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8650.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14476.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18280.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2013.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 663.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECALLANTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1290", "type": "HCPCS"}], "standard_charges": [{"minimum": 2045.67, "maximum": 2045.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2045.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 262.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 262.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 636.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 636.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 519.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 519.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO 2D LIMITED W/CONTR", "code_information": [{"code": "C8924", "type": "HCPCS"}, {"code": "4608924", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"gross_charge": 1897.0, "discounted_cash": 1422.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO 2D STRESS EKG W WO CM", "code_information": [{"code": "C8930", "type": "HCPCS"}, {"code": "4608930", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"gross_charge": 8003.0, "discounted_cash": 6002.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 121.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 175.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 194.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.4, 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"UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 106.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 58.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}, {"code": "4603400", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 477.88, "gross_charge": 7426.0, "discounted_cash": 5569.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 477.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 40.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 504.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 504.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 163.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 833.85, "maximum": 833.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 833.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 93.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 309.24, "maximum": 309.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 578.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 436.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 436.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRNSTHR 2D FU/LTD", "code_information": [{"code": "93308", "type": "CPT"}, {"code": "4603308", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 269.76, "gross_charge": 2002.0, "discounted_cash": 1501.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO2D DOP/COLFL W/CONTR", "code_information": [{"code": "C8929", "type": "HCPCS"}, {"code": "4608929", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"gross_charge": 3382.0, "discounted_cash": 2536.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO2D SPECTR/COLOR FLO", "code_information": [{"code": "93306", "type": "CPT"}, {"code": "4603306", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 468.17, "gross_charge": 9502.0, "discounted_cash": 7126.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 468.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOCARD RS/ST WCONT EKG", "code_information": [{"code": "93351", "type": "CPT"}, {"code": "4603351", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 549.19, "gross_charge": 2429.0, "discounted_cash": 1821.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 549.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 179.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOCARDIOGRAPHY CONTRAST", "code_information": [{"code": "A9700", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.42, "maximum": 450.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOGRAP TRANS R PROS STUDY", "code_information": [{"code": "76873", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 479.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 241.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 148.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 431.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 479.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 364.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 119.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOSCLEROTHERAPY", "code_information": [{"code": "S2202", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO CANNULATION >6YRS", "code_information": [{"code": "4613952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [{"code": "3", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38748.0, "maximum": 486778.74, "estimated_discounted_cash": 601312.36, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38748.0, "methodology": "per diem"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 256995.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 248080.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 239653.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230357.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 385492.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 486778.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO REMOVAL ART/VENOUS>6YRS", "code_information": [{"code": "4613966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18625.0, "discounted_cash": 13968.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 826.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1214.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 406.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1097.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2910.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2953.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 984.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1487.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 498.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1511.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1661.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1681.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 647.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 647.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 825.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 825.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1642.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 549.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 579.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1803.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 602.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1850.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 620.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 647.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 958.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 838.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1002.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ECMO/INIT DAY VENO-ARTERIAL", "code_information": [{"code": "4613947", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECMO/INIT DAY VENO-VENOUS", "code_information": [{"code": "4613946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 128.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1839.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 611.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECULIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1300", "type": "HCPCS"}], "standard_charges": [{"minimum": 856.02, "maximum": 856.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 856.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD GRP PER SESSION", "code_information": [{"code": "G0421", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD IND PER SESSION", "code_information": [{"code": "G0420", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 396.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 396.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EDETATE CALCIUM DISODIUM INJ", "drug_information": 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{"description": "EF ADULT FLUIDS AND ELECTRO", "code_information": [{"code": "B4102", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.23, "maximum": 11.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED CALORIC DENSE>/=0.7KC", "code_information": [{"code": "B4160", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.15, "maximum": 3.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE INTACT NUT", "code_information": [{"code": "B4158", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.63, "maximum": 4.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE SOY BASED", "code_information": [{"code": "B4159", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.88, "maximum": 5.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED FLUID AND ELECTROLYTE", "code_information": [{"code": "B4103", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.77, "maximum": 10.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED HYDROLYZED/AMINO ACID", "code_information": [{"code": "B4161", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.48, "maximum": 9.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EF PED SPECMETABOLIC INHERIT", "code_information": [{"code": "B4162", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.11, "maximum": 14.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIR/EMTRICT/TENOFV TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304464", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 898.0, "discounted_cash": 673.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIR/EMTRICT/TENOFV TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304464", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 898.0, "discounted_cash": 673.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIRENZ 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIRENZ 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304431", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIRENZ 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304424", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EFAVIRENZ 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304424", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 258.0, "discounted_cash": 193.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD BALLOON DIL ESOPH30 MM/>", "code_information": [{"code": "43233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "estimated_discounted_cash": 2672.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 822.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD BIOPSY SINGLE/MULTIPLE", "code_information": [{"code": "43239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 8018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 499.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 250.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 446.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 250.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD CAUTERY TUMOR POLYP", "code_information": [{"code": "43250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 611.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 293.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 533.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 293.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD CONTROL BLEEDING ANY", "code_information": [{"code": "43255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 5753.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 719.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 445.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 733.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 445.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD DIAGNOSTIC BRUSH WASH", "code_information": [{"code": "43235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 442.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 345.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD DILATE STRICTURE", "code_information": [{"code": "43245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 631.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 437.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 437.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 969.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 324.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ENDOSCOPIC STENT PLACE", "code_information": [{"code": "43266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 781.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 261.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1544.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1424.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 686.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 532.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 650.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2923.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 577.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 544.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD GUIDE WIRE INSERTION", "code_information": [{"code": "43248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 7988.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 598.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 260.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 260.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 853.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 285.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD LESION ABLATION", "code_information": [{"code": "43270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "estimated_discounted_cash": 5830.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 805.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 528.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 854.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 528.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 605.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 8018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 719.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 240.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE FOREIGN BODY", "code_information": [{"code": "43247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 9504.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 635.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 218.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 458.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 218.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD REMOVE LESION SNARE", "code_information": [{"code": "43251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6317.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 704.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 314.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 585.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 314.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 512.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 810.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 833.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 943.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 314.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [{"code": "43253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 942.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 315.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD VARICES LIGATION", "code_information": [{"code": "43244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6368.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 880.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 293.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1406.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 468.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGFR COMMON VARIANTS", "code_information": [{"code": "81235", "type": "CPT"}, {"code": "7251235", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1231.13, "gross_charge": 6569.0, "discounted_cash": 4926.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.46, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 546.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 193.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 214.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1231.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 292.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 24.14, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA AB", "code_information": [{"code": "86666", "type": "CPT"}, {"code": "7250666", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.61, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA AB/2", "code_information": [{"code": "86666", "type": "CPT"}, {"code": "7256643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.61, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0432", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.1, "maximum": 74.23, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG MNTR SCN W/RPT 48 HR", "code_information": [{"code": "93226", "type": "CPT"}, {"code": "4603277", "type": "CDM"}, {"code": "731", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 129.42, "gross_charge": 2194.0, "discounted_cash": 1645.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG MNTR UP TO 48 HRS", "code_information": [{"code": "93225", "type": "CPT"}, {"code": "4603275", "type": "CDM"}, {"code": "731", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.45, "gross_charge": 1878.0, "discounted_cash": 1408.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG TRACE ONLY", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "4603000", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.87, "gross_charge": 1226.0, "discounted_cash": 919.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EKG TRACING FOR INITIAL PREV", "code_information": [{"code": "G0404", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUAL/SEMIQ", "code_information": [{"code": "82656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW 2 VIEWS", "code_information": [{"code": "73070", "type": "CPT"}, {"code": "4903070", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.53, "gross_charge": 2592.0, "discounted_cash": 1944.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 85.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 95.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW 3 VIEW MINIMUM", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "4903080", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 124.95, "gross_charge": 2807.0, "discounted_cash": 2105.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY", "code_information": [{"code": "29830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1688.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 570.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1816.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 615.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1884.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 634.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2156.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 727.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1938.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 646.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2196.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 738.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC ALY CPX IINS SP/SAC NRV", "code_information": [{"code": "789T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALY SMP IINS SP/SAC NRV", "code_information": [{"code": "788T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS CPLX PRGRMG IINS", "code_information": [{"code": "590T", "type": "CPT"}], "standard_charges": [{"minimum": 60.69, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"minimum": 68.27, "maximum": 68.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"minimum": 55.66, "maximum": 94.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC MED COMP DEV, NOC", "code_information": [{"code": "T1505", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 45.21, "maximum": 45.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRIC WOUND TREATMENT DEV", "code_information": [{"code": "E0769", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 638.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 77.83, "maximum": 77.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 168.9, "maximum": 168.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 275.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 275.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 95.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM REPORT", "code_information": [{"code": "93010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 29.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 404.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 131.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 384.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 396.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 134.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIMULATION BRAIN", "code_information": [{"code": "95961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 616.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 616.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 205.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROEJACULATION", "code_information": [{"code": "55870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee 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"plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 219.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY", "code_information": [{"code": "91132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1495.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1495.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 473.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee 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"standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "4120004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.59, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "4150004", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.59, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.31, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "4180007", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 290.25, "setting": "both", "billing_class": "facility"}], "modifiers": "QW"}, {"description": "ELECTROMAGNTIC TX FOR ULCERS", "code_information": [{"code": "G0329", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.8, "setting": "outpatient", "payers_information": [{"payer_name": 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"standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 183.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": 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[{"minimum": 3.79, "maximum": 3.79, "gross_charge": 716.0, "discounted_cash": 537.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELVIT/COBI/EMTRIC/TEN TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304474", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 928.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELVIT/COBI/EMTRIC/TEN TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304474", "type": "CDM"}, {"code": 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"EMB MICROSPHR 500-700MIC", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8032146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EMB MICROSPHR 700-900MIC", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8032152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EMB MICROSPHR SPHERICL", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8032154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10274.0, "discounted_cash": 7705.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EMBEDDED IP CATH EXIT-SITE", "code_information": [{"code": "49436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH 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{"code": "5335378", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 183.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EMOLLIENT 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335327", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EMOLLIENT 60GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5335327", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "EMPAGLIFLOZIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304475", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": 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{"code": "7256653", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS ST LOUIS AB/5", "code_information": [{"code": "86653", "type": "CPT"}, {"code": "7258665", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS WEST EQ AB", "code_information": [{"code": "86654", "type": "CPT"}, {"code": "7256656", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "gross_charge": 204.0, "discounted_cash": 153.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END THXPY, ANTERIOR TOOTH", "code_information": [{"code": "D3310", "type": "HCPCS"}], "standard_charges": [{"minimum": 1030.98, "maximum": 1030.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1030.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END THXPY, MOLAR TOOTH", "code_information": [{"code": "D3330", "type": "HCPCS"}], "standard_charges": [{"minimum": 1412.1, "maximum": 1412.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1412.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END THXPY, PREMOLAR TOOTH", "code_information": [{"code": "D3320", "type": "HCPCS"}], "standard_charges": [{"minimum": 1160.39, "maximum": 1160.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1160.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 47.42, "maximum": 261.41, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CATH BILIARY SYSTEM", "code_information": [{"code": "74328", "type": "CPT"}, {"code": "4904328", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 3069.0, "discounted_cash": 2301.75, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CATH PANCREAS DUCT", "code_information": [{"code": "74329", "type": "CPT"}, {"code": "4904329", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 3666.0, "discounted_cash": 2749.5, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1215.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 405.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 3126.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1280.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 427.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO OUTLET RESTRICT W/TUBE", "code_information": [{"code": "C9785", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO RPR THOR AO W/LT SCA+S&I", "code_information": [{"code": "75956", "type": "CPT"}, {"code": "4615942", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 14690.0, "gross_charge": 22600.0, "discounted_cash": 16950.0, "setting": "both", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "standard_charge_dollar": 4520.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 595.35, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 5650.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 5650.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 11300.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11124.32, "maximum": 23507.35, "estimated_discounted_cash": 69169.06, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14858.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11980.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11573.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11124.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18616.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23507.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17865.12, "maximum": 37751.66, "estimated_discounted_cash": 109111.49, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23980.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19239.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18586.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17865.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29896.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37751.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8338.36, "maximum": 17620.19, "estimated_discounted_cash": 54401.88, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10460.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8979.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8674.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8338.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13953.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17620.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDODONTIC ENDOSSEOUS IMPLAN", "code_information": [{"code": "D3460", "type": "HCPCS"}], "standard_charges": [{"minimum": 1562.22, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1562.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDODONTIC PROCEDURE", "code_information": [{"code": "D3999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUM BX BILI TREE", "code_information": [{"code": "4917543", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16706.0, "discounted_cash": 12529.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUM BX URTR RNL PLVS", "code_information": [{"code": "4910606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3158.0, "discounted_cash": 2368.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 507.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 258.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 459.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 258.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 495.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 356.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 574.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 356.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETR ABLATE THERMAL", "code_information": [{"code": "58353", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5488.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 720.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 720.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION", "code_information": [{"code": "58356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5488.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1290.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1368.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1925.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1368.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMYSIAL AB", "code_information": [{"code": "86231", "type": "CPT"}, {"code": "7258676", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.32, "maximum": 45.86, "gross_charge": 456.0, "discounted_cash": 342.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH BLN VIABAHN V", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33385.0, "discounted_cash": 25038.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOPROSTH EXTENDER ILIAC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "4028017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29378.0, "discounted_cash": 22033.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH ILIAC BRANCH", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "4028019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 91006.0, "discounted_cash": 68254.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH INTRNL ILIAC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "4028018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 26088.0, "discounted_cash": 19566.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPROSTH PERIPH VIABAH", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4021031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 64651.0, "discounted_cash": 48488.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION/IMPLANT", "code_information": [{"code": "51715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 16870.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 720.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 426.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 703.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY BOWEL POUCH/BIOP", "code_information": [{"code": "44386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8379.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 322.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 231.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 231.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2241.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 749.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY MAXILLARY SINUS", "code_information": [{"code": "31267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 963.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF BOWEL POUCH", "code_information": [{"code": "44385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1103.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 464.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1172.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 132.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 724.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 242.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSTEAL IMPLANT", "code_information": [{"code": "D6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 2099.46, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 712.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3396.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1131.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1389.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 463.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6310.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2103.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5420.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1807.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2072.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5736.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5736.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6195.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6884.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 66511.53, "maximum": 140548.73, "estimated_discounted_cash": 519309.7, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 131004.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 71628.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 69195.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 66511.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 111304.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 140548.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"minimum": 51668.96, "maximum": 109184.19, "estimated_discounted_cash": 454543.39, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98365.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55644.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 53754.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 51668.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 86465.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 109184.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 637.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1909.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 313.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 166.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 986.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 725.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1138.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 725.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 643.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1057.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1367.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1057.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 315.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 295.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 986.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 821.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1234.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 821.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 472.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENFUVIRTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1324", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.2, "maximum": 2.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN PER 10MG PFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "5320394", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.58, "maximum": 2.58, "gross_charge": 57.0, "discounted_cash": 42.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN PER 10MG PFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "5320394", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.58, "maximum": 2.58, "gross_charge": 57.0, "discounted_cash": 42.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTACAPONE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304460", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTACAPONE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304460", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR IA", "code_information": [{"code": "87336", "type": "CPT"}, {"code": "4177337", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.69, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP IA", "code_information": [{"code": "87337", "type": "CPT"}, {"code": "7257339", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTECAVIR .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTECAVIR .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304458", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERAL SUPP NOT OTHERWISE C", "code_information": [{"code": "B9998", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8911.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2985.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10285.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3443.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256568", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.42, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AB/2", "code_information": [{"code": "86658", "type": "CPT"}, {"code": "7256569", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.42, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS AMP PROBE", "code_information": [{"code": "87498", "type": "CPT"}, {"code": "7258757", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 1043.0, "discounted_cash": 782.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY DFA", "code_information": [{"code": "87267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENVELOPE ECM IMPLANT DVC", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4028021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9551.0, "discounted_cash": 7163.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ENVELOPE NEURO ABSORB ANTIBACT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9241.0, "discounted_cash": 6930.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENVERSE, PER SQ CM", "code_information": [{"code": "Q4258", "type": "HCPCS"}], "standard_charges": [{"minimum": 279.35, "maximum": 279.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENVIRONMENTAL MANIPULATION", "code_information": [{"code": "90882", "type": "CPT"}], "standard_charges": [{"minimum": 297.67, "maximum": 297.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 297.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME ACTIVITY NES/2", "code_information": [{"code": "82657", "type": "CPT"}, {"code": "7252659", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.09, "gross_charge": 1454.0, "discounted_cash": 1090.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY", "code_information": [{"code": "82657", "type": "CPT"}, {"code": "7251313", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.09, "gross_charge": 1448.0, "discounted_cash": 1086.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY RA", "code_information": [{"code": "82658", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 167.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 167.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL BLOOD COUNT", "code_information": [{"code": "S3630", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EP CARDIAC MAPPING", "code_information": [{"code": "93609", "type": "CPT"}, {"code": "4610600", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 28149.0, "discounted_cash": 21111.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP COMP STUDY W/INDUCTN", "code_information": [{"code": "93620", "type": "CPT"}, {"code": "4610620", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 26194.0, "discounted_cash": 19645.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 720.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP EVAL AICD SUBSEQ", "code_information": [{"code": "93642", "type": "CPT"}, {"code": "4610642", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 3561.0, "discounted_cash": 2670.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 296.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP POST DRUG INFUSION", "code_information": [{"code": "93623", "type": "CPT"}, {"code": "4610631", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 26386.0, "discounted_cash": 19789.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3973.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EP TEST AICD LEAD & GEN", "code_information": [{"code": "93641", "type": "CPT"}, {"code": "4610635", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 19546.0, "discounted_cash": 14659.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPHEDRINE 50MG/1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320404", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPHEDRINE25MGNS 5MLPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320387", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPHEDRINE50MGNS 5MLPFSIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320389", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"minimum": 273.1, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPICORD PER SQ CM", "code_information": [{"code": "Q4187", "type": "HCPCS"}, {"code": "4028025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 932.22, "maximum": 932.22, "gross_charge": 1711.0, "discounted_cash": 1283.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 932.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPICORD PER SQ CM", "code_information": [{"code": "Q4187", "type": "HCPCS"}, {"code": "4028025", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 932.22, "maximum": 932.22, "gross_charge": 1711.0, "discounted_cash": 1283.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 932.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 497.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2539.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 119.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 991.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 119.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 365.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2603.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1009.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS MULT SESSIONS", "code_information": [{"code": "62263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1185.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDURAL LYSIS ON SINGLE DAY", "code_information": [{"code": "62264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 889.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 204.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 204.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIEFFECT, PER SQ CM", "code_information": [{"code": "Q4278", "type": "HCPCS"}], "standard_charges": [{"minimum": 2002.69, "maximum": 2002.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2002.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 2CM X 3CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028026", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1877.0, "discounted_cash": 1407.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 2CM X 3CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028026", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1877.0, "discounted_cash": 1407.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4005536", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 2040.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4005536", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 2040.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 3.5CM X 3.5CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028024", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1469.0, "discounted_cash": 1101.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 3.5CM X 3.5CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028024", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1469.0, "discounted_cash": 1101.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 4CM X 4.5CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028027", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1063.0, "discounted_cash": 797.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 4CM X 4.5CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028027", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1063.0, "discounted_cash": 797.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 4CMX4CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1877.0, "discounted_cash": 1407.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 4CMX4CM PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4028023", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1877.0, "discounted_cash": 1407.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4005534", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1527.0, "discounted_cash": 1145.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX PER SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}, {"code": "4005534", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 575.02, "maximum": 575.02, "gross_charge": 1527.0, "discounted_cash": 1145.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX, INJ, 1MG", "code_information": [{"code": "Q4145", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.88, "maximum": 73.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 1684.68, "maximum": 9287.39, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1684.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1871.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9287.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE 2.25%.5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330865", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE 2.25%.5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330865", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0165", "type": "HCPCS"}, {"code": "5320458", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EPINEPHRINE1:1000 30MLTS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330843", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 535.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14450.77, "maximum": 30536.62, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18856.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15562.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15033.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14450.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24182.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30536.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7966.1, "maximum": 16833.56, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9746.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8578.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8287.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7966.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13330.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16833.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPLERENONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPLERENONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0887", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.14, "maximum": 6.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA NON ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0888", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.14, "maximum": 6.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ESRD PER 100U IJ", "code_information": [{"code": "Q4081", "type": "HCPCS"}, {"code": "5320419", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.37, "maximum": 3.37, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ESRD PER 100U IJ", "code_information": [{"code": "Q4081", "type": "HCPCS"}, {"code": "5320419", "type": "CDM"}, {"code": "634", "type": "RC"}], "standard_charges": [{"minimum": 3.37, "maximum": 3.37, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN NON-ESRD 1000U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0885", "type": "HCPCS"}, {"code": "5320431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 33.7, "maximum": 33.7, "gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN NON-ESRD 1000U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0885", "type": "HCPCS"}, {"code": "5320431", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 33.7, "maximum": 33.7, "gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX ESRD PER 100U IJ", "code_information": [{"code": "Q5105", "type": "HCPCS"}, {"code": "5320471", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.97, "maximum": 2.97, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX ESRD PER 100U IJ", "code_information": [{"code": "Q5105", "type": "HCPCS"}, {"code": "5320471", "type": "CDM"}, {"code": "634", "type": "RC"}], "standard_charges": [{"minimum": 2.97, "maximum": 2.97, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX NON-ESRD 1000U IJ", "code_information": [{"code": "Q5106", "type": "HCPCS"}, {"code": "5320472", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 29.68, "maximum": 29.68, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN-EPBX NON-ESRD 1000U IJ", "code_information": [{"code": "Q5106", "type": "HCPCS"}, {"code": "5320472", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.68, "maximum": 29.68, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL DILUTANT", "code_information": [{"code": "S0155", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.71, "maximum": 45.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL PER .5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1325", "type": "HCPCS"}, {"code": "5320450", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 60.54, "maximum": 60.54, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL PER .5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1325", "type": "HCPCS"}, {"code": "5320450", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 60.54, "maximum": 60.54, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS EA AB", "code_information": [{"code": "86663", "type": "CPT"}, {"code": "7256693", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.76, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS NA AB", "code_information": [{"code": "86664", "type": "CPT"}, {"code": "7256663", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.99, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.72, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR VIRUS VCA AB", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "7256262", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.81, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE 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"type": "EA"}, "code_information": [{"code": "J1327", "type": "HCPCS"}, {"code": "5320449", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 41.5, "maximum": 41.5, "gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL I", "code_information": [{"code": "99281", "type": "CPT"}, {"code": "6100510", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 695.0, "gross_charge": 1297.0, "discounted_cash": 972.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 373.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL II", "code_information": [{"code": "99282", "type": "CPT"}, {"code": "6100522", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 695.0, "gross_charge": 1952.0, "discounted_cash": 1464.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL III", "code_information": [{"code": "99283", "type": "CPT"}, {"code": "6100524", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1454.0, "gross_charge": 3037.0, "discounted_cash": 2277.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1454.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1012.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL IV", "code_information": [{"code": "99284", "type": "CPT"}, {"code": "6100526", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2111.0, "gross_charge": 4940.0, "discounted_cash": 3705.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2111.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 438.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ER VISIT LVL V", "code_information": [{"code": "99285", "type": "CPT"}, {"code": "6100527", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1284.07, "gross_charge": 5707.0, "discounted_cash": 4280.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1284.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 635.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 212.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 775.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP BILIARY&PANCREATIC", "code_information": [{"code": "74330", "type": "CPT"}, {"code": "4904200", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 3967.0, "discounted_cash": 2975.25, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP DUCT STENT PLACEMENT", "code_information": [{"code": "43274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1659.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1357.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 452.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LESION ABLATE W/DILATE", "code_information": [{"code": "43278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1553.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12193.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8420.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1553.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE DUCT CALCULI", "code_information": [{"code": "43264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1305.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 436.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 9780.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1349.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 450.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY&ENDO", "code_information": [{"code": "C7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1282.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 428.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1727.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 575.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/ PANCREATOSCOPY", "code_information": [{"code": "C7541", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/BX & PANCREATOSCOPY", "code_information": [{"code": "C7542", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "405U", "type": "CPT"}], "standard_charges": [{"minimum": 1206.08, "maximum": 6715.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1206.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1340.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6715.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP W/OTOMY, PANCREATOSCOPY", "code_information": [{"code": "C7543", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/SPECIMEN COLLECTION", "code_information": [{"code": "43260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", 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"OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 386.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERGOCALCIFERL8000U/ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315126", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ERGOCALCIFERL8000U/ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315126", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ERGOCALCIFEROL 50000U CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304469", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"ERLOTINIB 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5304602", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1001.0, "discounted_cash": 750.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERTAPENEM PER 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "5320491", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 49.18, "maximum": 49.18, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERTAPENEM PER 500MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "5320491", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 49.18, "maximum": 49.18, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERWINAZE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9019", "type": "HCPCS"}], "standard_charges": [{"minimum": 1620.63, "maximum": 1620.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1620.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 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"facility"}]}, {"description": "ERYTHROMYC BASE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304647", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYC BASE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304647", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, 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"type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 306.38, "maximum": 306.38, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315140", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN NEO CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315140", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "4102668", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.27, "gross_charge": 594.0, "discounted_cash": 445.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "4120028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.27, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "4150027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.27, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "4170063", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.27, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "7252668", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.27, "gross_charge": 327.0, "discounted_cash": 245.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO A, PER SQ CM", "code_information": [{"code": "Q4272", "type": "HCPCS"}], "standard_charges": [{"minimum": 1128.42, "maximum": 1128.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1128.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESANO AC, PER SQ CM", "code_information": [{"code": "Q4274", "type": "HCPCS"}], "standard_charges": [{"minimum": 4755.47, "maximum": 4755.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4755.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 296.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304665", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304666", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESCITALOPRAM 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304666", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESKETAMINE, NASAL SPRAY", "code_information": [{"code": "S0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.83, "maximum": 50.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESMOLOL PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}, {"code": "5320528", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESMOLOL PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}, {"code": "5320528", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESMOLOL PER 10MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}, {"code": "5320529", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESMOLOL PER 10MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}, {"code": "5320529", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1699.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 538.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH EGD DILATION <30 MM", "code_information": [{"code": "43249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 5191.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1237.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 958.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH ENDOSCOPY DILATION", "code_information": [{"code": "43226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9536.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 470.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 267.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 459.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 267.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2958.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1014.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4011.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1340.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 401.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TST", "code_information": [{"code": "91037", "type": "CPT"}, {"code": "5071251", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "gross_charge": 2134.0, "discounted_cash": 1600.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 439.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 405.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 135.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPH MOTILITY STUDY", "code_information": [{"code": "91010", "type": "CPT"}, {"code": "5071062", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "gross_charge": 4173.0, "discounted_cash": 3129.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 477.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH PH TST W ELECT", "code_information": [{"code": "91035", "type": "CPT"}, {"code": "5071254", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "gross_charge": 3952.0, "discounted_cash": 2964.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1361.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 432.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH PH TST W NSL CATH", "code_information": [{"code": "91034", "type": "CPT"}, {"code": "5071253", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "gross_charge": 3507.0, "discounted_cash": 2630.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 167.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 486.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10890.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 374.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 312.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/ESO EGD", "code_information": [{"code": "C9777", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 896.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 357.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 317.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 806.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 896.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 598.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 197.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13764.86, "maximum": 29087.19, "estimated_discounted_cash": 87427.58, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17447.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14823.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14320.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13764.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23034.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29087.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8461.0, "maximum": 17879.35, "estimated_discounted_cash": 60631.71, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10763.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9111.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8802.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8461.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14159.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17879.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4840.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4840.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1621.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4801.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1607.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10487.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10487.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3515.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC DILATE BALLOON 30", "code_information": [{"code": "43214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 699.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSC FLEX TRNSN BIOPSY", "code_information": [{"code": "43198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 354.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 258.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 843.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP STENT PLACEMENT", "code_information": [{"code": "43212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 678.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 227.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 565.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY BALLOON <30MM", "code_information": [{"code": "43220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 808.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1033.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 808.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 594.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 448.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 448.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX BIOPSY", "code_information": [{"code": "43202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 372.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 264.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 264.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX DX BRUSH", "code_information": [{"code": "43197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 296.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 114.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEX REMOVE FB", "code_information": [{"code": "43215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 263.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 466.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 263.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY FLEXIBLE BRUSH", "code_information": [{"code": "43200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 318.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 184.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 314.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 184.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION ABLATE", "code_information": [{"code": "43229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 707.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 535.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 827.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 535.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY LESION REMOVAL", "code_information": [{"code": "43216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 288.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 482.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 288.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RETRO BALLOON", "code_information": [{"code": "43213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "estimated_discounted_cash": 9112.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 933.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1000.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1412.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1000.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 673.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 25558.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2000.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 670.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO DX", "code_information": [{"code": "43191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 566.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 190.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 576.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 274.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 499.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 274.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W/US NEEDLE BX", "code_information": [{"code": "43232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 715.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 238.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP GUIDE WIRE DILAT", "code_information": [{"code": "43196", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 713.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 616.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO INJECT", "code_information": [{"code": "43192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 618.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", "code_information": [{"code": "43194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 690.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 234.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS ENDOSCOPY/LIGATION", "code_information": [{"code": "43205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 508.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 169.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS IMAGE CAP PROC", "code_information": [{"code": "91111", "type": "CPT"}, {"code": "5071111", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3016.31, "gross_charge": 6887.0, "discounted_cash": 5165.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3016.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 948.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS W/DBL CONTRAST", "code_information": [{"code": "74221", "type": "CPT"}, {"code": "4904221", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 293.46, "gross_charge": 1507.0, "discounted_cash": 1130.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 264.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 293.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12687.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12687.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4235.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13381.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13381.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4472.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11352.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11352.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3811.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12338.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12338.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4069.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 12-19", "code_information": [{"code": "90965", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1814.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1814.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 2-11", "code_information": [{"code": "90964", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1890.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1890.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 20+", "code_information": [{"code": "90966", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1067.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1067.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO <2YRS", "code_information": [{"code": "90963", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2205.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2205.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 735.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 736.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 736.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 2030.62, "maximum": 2030.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2030.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1185.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1185.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 397.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"minimum": 3048.81, "maximum": 3048.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3048.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4256.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4256.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1412.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3650.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3650.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1217.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1265.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 12-19", "code_information": [{"code": "90958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1818.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1818.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 608.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 2-11", "code_information": [{"code": "90955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1897.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1897.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 636.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1067.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1067.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1286.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1286.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 432.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2794.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2794.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 933.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 11.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 437.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 442.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 649.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 442.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 537.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 395.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 634.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 395.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5841.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1956.24, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3417.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3647.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1218.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5031.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1685.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3565.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1191.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3786.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1263.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "7252670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 105.98, "gross_charge": 517.0, "discounted_cash": 387.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 54.27, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .025WEEK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335358", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .025WEEK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335358", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .05BIWK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335360", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .05BIWK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335360", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .075WEEK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335372", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .075WEEK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335372", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 32.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .1BIWK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335361", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL .1BIWK EA TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335361", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304673", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304673", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304674", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304674", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL VALERATE 10 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1380", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.03, "maximum": 35.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL.1MG/GM42.5GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335363", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 678.0, "discounted_cash": 508.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL.1MG/GM42.5GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335363", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 678.0, "discounted_cash": 508.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROG/METH.625/1.25MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304712", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROG/METH.625/1.25MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304712", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN CONJ PER25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}, {"code": "5320542", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1411.55, "maximum": 1411.55, "gross_charge": 681.0, "discounted_cash": 510.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1411.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN CONJ PER25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}, {"code": "5320542", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1411.55, "maximum": 1411.55, "gross_charge": 681.0, "discounted_cash": 510.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1411.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN ESTRFD.625MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304708", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN ESTRFD.625MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304708", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGENS FRACTIONATED", "code_information": [{"code": "82671", "type": "CPT"}, {"code": "7252671", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 122.51, "gross_charge": 255.0, "discounted_cash": 191.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 62.73, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 72.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 33.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 37.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 122.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGENS TOTAL", "code_information": [{"code": "82672", "type": "CPT"}, {"code": "7252672", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.31, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTRONE", "code_information": [{"code": "82679", "type": "CPT"}, {"code": "7252001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.64, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 48.48, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 56.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1278.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESWL FOR GALLSTONES", "code_information": [{"code": "S9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 12193.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESZOPICLONE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304721", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESZOPICLONE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304721", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESZOPICLONE 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304722", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESZOPICLONE 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304722", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 68.0, "discounted_cash": 51.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETANERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1438", "type": "HCPCS"}], "standard_charges": [{"minimum": 1561.62, "maximum": 1561.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1561.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHACRYNATE SOD PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1807", "type": "HCPCS"}, {"code": "5320554", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.08, "discounted_cash": 30.81, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHACRYNATE SOD PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1807", "type": "HCPCS"}, {"code": "5320554", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 41.08, "discounted_cash": 30.81, "setting": "both", "billing_class": "facility"}]}, {"description": "ETHACRYNIC ACID 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304743", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHACRYNIC ACID 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304743", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHAMBUTOL 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304774", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHANOL99% 5ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5318077", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5604.0, "discounted_cash": 4203.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHANOLAMINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}, {"code": "5320560", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1797.63, "maximum": 1797.63, "gross_charge": 2829.0, "discounted_cash": 2121.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1797.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHANOLAMINE PER100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}, {"code": "5320560", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1797.63, "maximum": 1797.63, "gross_charge": 2829.0, "discounted_cash": 2121.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1797.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHIODIZED OIL48%10MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5355920", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4895.0, "discounted_cash": 3671.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHIONAMIDE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304814", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHOSUXAMIDE 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304859", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHYL CHLOR ONE DOSE SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHYL CHLOR ONE DOSE SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHYLENE GLYCOL", "code_information": [{"code": "82693", "type": "CPT"}, {"code": "7252691", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.52, "gross_charge": 841.0, "discounted_cash": 630.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETIDRONATE DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1436", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.63, "maximum": 306.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOMIDATE20MG/10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320609", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 436.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOMIDATE40MG/20ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320611", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 995.0, "discounted_cash": 746.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETONOGESTREL IMPLANT SYSTEM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7307", "type": "HCPCS"}], "standard_charges": [{"minimum": 4247.36, "maximum": 4247.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4247.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE ORAL 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8560", "type": "HCPCS"}], "standard_charges": [{"minimum": 290.58, "maximum": 290.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9181", "type": "HCPCS"}, {"code": "5320614", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.77, "maximum": 3.77, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9181", "type": "HCPCS"}, {"code": "5320614", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.77, "maximum": 3.77, "gross_charge": 304.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETRAVIRINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304892", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETRAVIRINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304892", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUFLEXXA INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7323", "type": "HCPCS"}], "standard_charges": [{"minimum": 482.85, "maximum": 482.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 482.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5076.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3453.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5384.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1796.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVACUATE MOLE OF UTERUS", "code_information": [{"code": "59870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1966.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 650.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL AMNIOTIC FLUID PROTEIN", "code_information": [{"code": "84112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 372.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 125.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 66.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 73.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 372.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ANTITACH PACEMAKER", "code_information": [{"code": "93724", "type": "CPT"}, {"code": "4613724", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 168.14, "gross_charge": 2783.0, "discounted_cash": 2087.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL ANTITACH PACEMAKER", "code_information": [{"code": "93724", "type": "CPT"}, {"code": "4613724", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 168.14, "gross_charge": 2783.0, "discounted_cash": 2087.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 56.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 270.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVAL W/ANALYSIS PM OR LDLES", "code_information": [{"code": "93288", "type": "CPT"}, {"code": "4613288", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 130.63, "gross_charge": 330.0, "discounted_cash": 247.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 409.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 409.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 257.73, "estimated_discounted_cash": 1008.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.22, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION FOR WHEELCHAIR", "code_information": [{"code": "G9156", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.93, "maximum": 37.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION HEART DEVICE", "code_information": [{"code": "93640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 489.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 130.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2092.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 704.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 893.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 300.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4360.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1458.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6509.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2113.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8024.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8024.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2681.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4842.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1615.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8072.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8072.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2685.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4095.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1370.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6414.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2141.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4367.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1455.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3469.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1157.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2761.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15119.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}, {"code": "7252532", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.08, "gross_charge": 452.0, "discounted_cash": 339.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 34.29, "maximum": 34.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TST COMPLETE", "code_information": [{"code": "92588", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP 5 CM/>", "code_information": [{"code": "24073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2538.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 853.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX ARM/ELBOW TUM DEEP < 5 CM", "code_information": [{"code": "24076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2014.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 677.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 0.36, "maximum": 115.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 5.72, "maximum": 311.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 455.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 455.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 178.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 178.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM FECES FOR MEAT FIBERS", "code_information": [{"code": "89160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM MACRO PARASITE", "code_information": [{"code": "87169", "type": "CPT"}, {"code": "7257174", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.35, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXAM OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 331.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 326.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 443.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 412.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC 3 CM/>", "code_information": [{"code": "22903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 22862.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1613.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 541.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD LES SC < 3 CM", "code_information": [{"code": "22902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1228.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 573.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM 5 CM OR LESS", "code_information": [{"code": "49203", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4336.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 10 CM", "code_information": [{"code": "49205", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6337.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 5 CM", "code_information": [{"code": "49204", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5525.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP 5 CM/>", "code_information": [{"code": "22901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2435.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [{"code": "22900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2073.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 697.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC 3 CM/>", "code_information": [{"code": "24071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 21773.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1490.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 500.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ARM/ELBOW LES SC < 3 CM", "code_information": [{"code": "24075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 27930.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1216.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 208.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 208.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC 3 CM/>", "code_information": [{"code": "21931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 21813.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1721.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 578.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK LES SC < 3 CM", "code_information": [{"code": "21930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 611.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP 5 CM/>", "code_information": [{"code": "21933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 12487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2694.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 903.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP < 5 CM", "code_information": [{"code": "21932", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "estimated_discounted_cash": 15817.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2423.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 816.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BIOPSY OF SALIV GLANDS", "code_information": [{"code": "D7284", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6075.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2027.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5544.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1870.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4160.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1387.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.5CM<", "code_information": [{"code": "11640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 463.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 0.6-1", "code_information": [{"code": "11641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 566.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 1.1-2", "code_information": [{"code": "11642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 662.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 325.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 2.1-3", "code_information": [{"code": "11643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 825.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 384.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG 3.1-4", "code_information": [{"code": "11644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1022.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 114.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 472.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 114.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC F/E/E/N/L MAL+MRG >4 CM", "code_information": [{"code": "11646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1410.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 613.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SBQ 2 CM/>", "code_information": [{"code": "21012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1246.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 418.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE LES SC <2 CM", "code_information": [{"code": "21011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 959.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 456.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP 2 CM/>", "code_information": [{"code": "21014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1912.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP < 2 CM", "code_information": [{"code": "21013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1476.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 649.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.5 CM/<", "code_information": [{"code": "11440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 0.6-1 CM", "code_information": [{"code": "11441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 1.1-2 CM", "code_information": [{"code": "11442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 22724.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 2.1-3 CM", "code_information": [{"code": "11443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 656.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 3.1-4 CM", "code_information": [{"code": "11444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 825.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [{"code": "11446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1158.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEEP <1.5CM", "code_information": [{"code": "28045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1280.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 586.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEP 1.5CM/>", "code_information": [{"code": "28041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1659.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC 1.5 CM/>", "code_information": [{"code": "28039", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1246.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 572.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM SC < 1.5 CM", "code_information": [{"code": "28043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 12083.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 964.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC 3 CM/>", "code_information": [{"code": "25071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 20967.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1562.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 525.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM LES SC < 3 CM", "code_information": [{"code": "25075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 21833.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1168.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 209.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 209.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP 3 CM/>", "code_information": [{"code": "25073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 19741.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1977.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [{"code": "25076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1919.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 646.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.5/<", "code_information": [{"code": "11420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 11159.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 400.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 1.1-2", "code_information": [{"code": "11422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 498.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 218.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 2.1-3", "code_information": [{"code": "11423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 18149.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 576.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG 3.1-4", "code_information": [{"code": "11424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9+MARG >4 CM", "code_information": [{"code": "11426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 13611.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 979.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 402.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP MAL+MARG 0.5/<", "code_information": [{"code": "11620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC 1.5 CM/>", "code_information": [{"code": "26111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 27222.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1540.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND LES SC < 1.5 CM", "code_information": [{"code": "26115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1236.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 224.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 224.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP 1.5 CM/>", "code_information": [{"code": "26113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 48925.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2025.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 682.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP < 1.5 CM", "code_information": [{"code": "26116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24700.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1945.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 656.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP PELVIS LES SC 3 CM/>", "code_information": [{"code": "27043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 23376.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1719.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2682.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 901.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP < 5 CM", "code_information": [{"code": "27048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 33972.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2246.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 756.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELVIS LES SC < 3 CM", "code_information": [{"code": "27047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1331.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 599.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE LES SC 3 CM/>", "code_information": [{"code": "27632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1500.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 505.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM < 3 CM", "code_information": [{"code": "27618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1129.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 586.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEEP <5 CM", "code_information": [{"code": "27619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1734.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 576.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEP 5 CM/>", "code_information": [{"code": "27634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2464.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 824.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC 3 CM/>", "code_information": [{"code": "21552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 31863.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1639.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 550.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK LES SC < 3 CM", "code_information": [{"code": "21555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 18269.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1131.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 131.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 131.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP 5 CM/>", "code_information": [{"code": "21554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2674.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 896.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUM DEEP < 5 CM", "code_information": [{"code": "21556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1943.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA W/ IMPLNT NV END", "code_information": [{"code": "C7551", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3002.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1005.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL PART", "code_information": [{"code": "45171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 12487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2253.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 755.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3013.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 543.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 1.1-2", "code_information": [{"code": "11622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 617.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 307.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 2.1-3", "code_information": [{"code": "11623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 760.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 3.1-4", "code_information": [{"code": "11624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 864.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 105.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 105.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG >4 CM", "code_information": [{"code": "11626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1055.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 493.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC 3 CM/>", "code_information": [{"code": "23071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 19021.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1542.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER LES SC < 3 CM", "code_information": [{"code": "23075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 35679.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1215.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 623.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP 5 CM/>", "code_information": [{"code": "23073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2552.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [{"code": "23076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1997.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 674.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD", "code_information": [{"code": "15830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4263.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1436.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKIN ABD ADD-ON", "code_information": [{"code": "15847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1379.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1287.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 203.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 657.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 203.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U SMPL/NTRM", "code_information": [{"code": "11470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1051.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 549.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX COMPLEX", "code_information": [{"code": "11451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1212.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 201.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 636.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 201.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX SMPL/NTRM", "code_information": [{"code": "11450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 960.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING COMPLEX", "code_information": [{"code": "11463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1219.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 207.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 636.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 207.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING SMPL/NTRM", "code_information": [{"code": "11462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 914.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 176.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 509.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 176.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC 3 CM/>", "code_information": [{"code": "27337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 18899.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1540.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES SC < 3 CM", "code_information": [{"code": "27327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1164.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 192.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 192.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEEP <5CM", "code_information": [{"code": "27328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2291.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEP 5CM/>", "code_information": [{"code": "27339", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 33972.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2766.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 927.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 0.5 CM<", "code_information": [{"code": "11400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 0.6-1 CM", "code_information": [{"code": "11401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 387.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 188.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 1.1-2 CM", "code_information": [{"code": "11402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 20451.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 424.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 208.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 2.1-3CM", "code_information": [{"code": "11403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10780.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 549.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG 3.1-4 CM", "code_information": [{"code": "11404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 17762.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 603.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 273.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT B9+MARG >4.0 CM", "code_information": [{"code": "11406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 19167.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 908.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [{"code": "11600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 447.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.6-1 CM", "code_information": [{"code": "11601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 1.1-2 CM", "code_information": [{"code": "11602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 588.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 88.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 297.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 88.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 2.1-3 CM", "code_information": [{"code": "11603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 339.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 3.1-4 CM", "code_information": [{"code": "11604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 772.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 378.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG >4 CM", "code_information": [{"code": "11606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1148.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/B9 TUM RDS", "code_information": [{"code": "24120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1975.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM AGRF", "code_information": [{"code": "24115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2718.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 913.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM ALGR", "code_information": [{"code": "24116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3159.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1060.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS AGRF", "code_information": [{"code": "24125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2305.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 775.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS ALGR", "code_information": [{"code": "24126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2405.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 809.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG B1 CST/B9 TUM HUM", "code_information": [{"code": "24110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2188.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCAVATE TOOTH NON-RESTORABL", "code_information": [{"code": "D2989", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCH ABSC/CYST DRN CATH", "code_information": [{"code": "4919423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6792.0, "discounted_cash": 5094.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCH ABSC/CYST DRN CATH", "code_information": [{"code": "5059423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6792.0, "discounted_cash": 5094.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCH BIL CATH W/ RMV CALCULI", "code_information": [{"code": "C7545", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCH NEPH CATH W/ DIL STRIC", "code_information": [{"code": "C7548", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 467.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 517.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 517.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 529.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 673.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 529.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE LENS PROSTHESIS", "code_information": [{"code": "66986", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4854.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5393.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3265.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1086.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 17923.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 356.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 511.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 690.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 511.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 183.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 123.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 228.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 123.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4194.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1411.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ANAL EXT TAG/PAPILLA", "code_information": [{"code": "46220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1186.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 550.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3666.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1232.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN & TISSUE", "code_information": [{"code": "15839", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2699.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1091.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2615.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1062.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2373.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 799.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN ARM", "code_information": [{"code": "15836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2909.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 979.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3393.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1142.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3256.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1096.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3199.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1076.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3361.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1138.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1291.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 628.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1086.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6453.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6453.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2155.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INFERIOR TURBINATE", "code_information": [{"code": "30130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1529.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 506.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3089.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1032.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRASPINL LESION CRV", "code_information": [{"code": "63265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6095.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2033.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION CRVL", "code_information": [{"code": "63270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7571.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2534.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5013.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1680.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6828.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2303.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5354.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1793.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6818.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2282.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6257.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2096.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7551.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2532.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE LESION TESTIS", "code_information": [{"code": "54512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1964.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 660.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LIP OR CHEEK FOLD", "code_information": [{"code": "40819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 731.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 332.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4413.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1486.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MANDIBLE LESION", "code_information": [{"code": "21040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1325.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 105.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 105.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA B9 TUMOR", "code_information": [{"code": "21030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1320.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 562.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4109.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1580.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 971.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 438.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2313.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 771.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 44547.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3877.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1295.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4336.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1450.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3076.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1029.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4927.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1647.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE PHARYNX LESION", "code_information": [{"code": "42808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 611.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 70.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 70.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8037.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2678.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1342.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 113.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 576.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 113.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBMAXILLARY GLAND", "code_information": [{"code": "42440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1532.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 511.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE TENDON FOREARM/WRIST", "code_information": [{"code": "25109", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1989.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 670.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE WRIST TENDON SHEATH", "code_information": [{"code": "25118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1430.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 481.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 99.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 99.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/REPAIR MOUTH LESION", "code_information": [{"code": "40814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1036.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 455.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION ADDL BREAST LESION", "code_information": [{"code": "19126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION COMPL", "code_information": [{"code": "D7412", "type": "HCPCS"}], "standard_charges": [{"minimum": 1212.51, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1212.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION>1.25C", "code_information": [{"code": "D7411", "type": "HCPCS"}], "standard_charges": [{"minimum": 923.25, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 923.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BREAST LESION", "code_information": [{"code": "19125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1690.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 700.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION CONSTRICTING TISSUE", "code_information": [{"code": "26596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3011.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6742.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2254.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 44281.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2009.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 667.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1698.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5935.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1982.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 895.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3127.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1037.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION HYPERPLASTIC TISSUE", "code_information": [{"code": "D7970", "type": "HCPCS"}], "standard_charges": [{"minimum": 889.42, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 889.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 495.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 262.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 587.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 94.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 306.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 94.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1185.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 546.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LES COMPLICAT", "code_information": [{"code": "D7415", "type": "HCPCS"}], "standard_charges": [{"minimum": 1579.06, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1579.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION<=1.25C", "code_information": [{"code": "D7413", "type": "HCPCS"}], "standard_charges": [{"minimum": 1113.21, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1113.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION>1.25CM", "code_information": [{"code": "D7414", "type": "HCPCS"}], "standard_charges": [{"minimum": 1568.18, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1568.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ANAL LESION(S)", "code_information": [{"code": "46922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 21703.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 505.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 183.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 183.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4822.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4822.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1614.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5642.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5642.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1881.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7207.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2412.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BONE LOWER JAW", "code_information": [{"code": "21025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2423.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 984.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3546.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1189.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2829.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 945.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BRAIN TUMOR", "code_information": [{"code": "61545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11576.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11576.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3874.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2339.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 780.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3613.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1208.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FACIAL BONE(S)", "code_information": [{"code": "21026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1572.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 200.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 737.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 431.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1347.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 643.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 103.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 264.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 103.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 713.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1056.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 529.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 810.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 137.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 430.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 137.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3732.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1253.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2152.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 715.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3094.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1037.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 449.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1115.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "41116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 794.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 122.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 122.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NAIL FOLD TOE", "code_information": [{"code": "11765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 76.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 200.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 76.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1044.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 473.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NECK CYST", "code_information": [{"code": "42815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1978.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 659.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PENIS LESION(S)", "code_information": [{"code": "54060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 483.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3729.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1250.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3928.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1315.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4704.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4704.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1574.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1551.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 520.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY CYST", "code_information": [{"code": "42408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 201.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 657.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 201.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY GLAND", "code_information": [{"code": "D7981", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4448.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7223.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2417.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8756.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2931.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6871.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6871.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2300.07, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8742.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2927.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3545.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1185.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4454.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4454.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1491.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE FOLD", "code_information": [{"code": "41115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 537.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 120.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 312.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 120.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 477.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 890.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 411.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 967.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 439.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2276.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 759.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL TAGS", "code_information": [{"code": "42860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 720.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UMBILICUS", "code_information": [{"code": "49250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2171.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 730.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UVULA", "code_information": [{"code": "42140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 601.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 371.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OLECRANON BURSA", "code_information": [{"code": "24105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 42970.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1347.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION PERICORONAL GINGIVA", "code_information": [{"code": "D7971", "type": "HCPCS"}], "standard_charges": [{"minimum": 378.69, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 378.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION RADIAL HEAD", "code_information": [{"code": "24130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1896.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3721.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1246.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2959.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 993.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXEMESTANE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304870", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXEMESTANE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304870", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXEMESTANE, 25 MG", "code_information": [{"code": "S0156", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.02, "maximum": 23.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM W/ECG", "code_information": [{"code": "94617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 210.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM WO ECG", "code_information": [{"code": "94619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 159.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXFOLIATIVE CYTOLOG COLLECT", "code_information": [{"code": "D7287", "type": "HCPCS"}], "standard_charges": [{"minimum": 244.5, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXFX HOF CON ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8972.0, "discounted_cash": 6729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 163.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 163.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 151.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 140.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 288.0, "maximum": 1213.76, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 289.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 322.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1213.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 4302.0, "maximum": 18130.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4329.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4811.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18130.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 10800.0, "maximum": 45516.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10869.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12077.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45516.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1478.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 497.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1579.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 529.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1462.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND ABDOMEN", "code_information": [{"code": "49010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3336.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1121.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2956.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 977.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1799.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2506.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 840.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1252.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 515.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1884.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 785.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION MAXILLARY SINUS", "code_information": [{"code": "31256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 653.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 219.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "49000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2791.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 936.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3656.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ANKLE JOINT", "code_information": [{"code": "27612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2109.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 712.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3847.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1287.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2908.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 976.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1832.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 613.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2835.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 950.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1347.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 647.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FOOT JOINT", "code_information": [{"code": "28022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1209.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 163.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 590.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 163.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1747.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 578.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3037.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1005.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF HIP JOINT", "code_information": [{"code": "27033", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3555.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1196.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2571.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 861.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KNEE JOINT", "code_information": [{"code": "27310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2699.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF MIDDLE EAR", "code_information": [{"code": "69440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2542.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 837.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4062.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1339.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINAL FUSION", "code_information": [{"code": "22830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3013.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1011.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF TOE JOINT", "code_information": [{"code": "28024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1139.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 158.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 158.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF URETER", "code_information": [{"code": "50600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3401.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1141.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF VAGINA", "code_information": [{"code": "57000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 741.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION SPHENOID SINUS", "code_information": [{"code": "31050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1898.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 629.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4239.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1423.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5995.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5995.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2009.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4160.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1395.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6811.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2269.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2642.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 887.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2085.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 694.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4372.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1469.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3917.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1312.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4536.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4536.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1510.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3310.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1110.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7152.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7152.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2394.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1918.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1322.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3767.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1251.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3374.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1118.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2994.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2649.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 889.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7339.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2456.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 36646.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3533.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1182.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5101.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5101.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1702.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE SCROTUM", "code_information": [{"code": "55110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1423.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 478.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2181.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 726.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3526.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1184.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2455.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 824.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND ABDOMEN", "code_information": [{"code": "20102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 931.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 372.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 718.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 372.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 760.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 381.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 669.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 381.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND EXTREMITY", "code_information": [{"code": "20103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1258.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 229.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 679.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 229.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND NECK", "code_information": [{"code": "20100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2177.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 729.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3767.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1238.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1664.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3293.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1080.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4884.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1606.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 426.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5292.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5292.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1777.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2374.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 797.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1656.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 557.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3593.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1178.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3501.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1150.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6298.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2077.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5035.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1655.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 16613.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1264.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT FINGER JOINT", "code_information": [{"code": "26080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1489.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 501.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT HAND JOINT", "code_information": [{"code": "26070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1207.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 405.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT KNEE JOINT", "code_information": [{"code": "27331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1769.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 596.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2067.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1514.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5272.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1735.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5544.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1827.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPOSURE OF UNERUPTED TOOTH", "code_information": [{"code": "D7280", "type": "HCPCS"}], "standard_charges": [{"minimum": 667.91, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT CANNULA DECLOTTING", "code_information": [{"code": "5600979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 1529.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 939.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 939.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 324.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 812.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 812.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 282.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REC SCAN A/R", "code_information": [{"code": "93245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 988.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 988.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 337.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 852.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 852.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXT FEM-FEM BYPASS", "code_information": [{"code": "4613770", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3370.0, "discounted_cash": 2527.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDER BUTTN TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2323.0, "discounted_cash": 1742.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 226546.49, "maximum": 489652.37, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 226546.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 249544.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 241068.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 231716.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 387767.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489652.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40147.79, "maximum": 89309.58, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40147.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 45515.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 43969.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42263.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70726.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 89309.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3682.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1220.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5953.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1977.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3902.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1311.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4929.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1647.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6656.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2220.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5209.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5209.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1736.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4376.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1464.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4597.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1527.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6118.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2043.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26682.1, "maximum": 56383.24, "estimated_discounted_cash": 216031.12, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41011.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28734.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27758.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26682.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44651.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56383.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50920.11, "maximum": 107601.74, "estimated_discounted_cash": 302018.16, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 72798.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 54837.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 52975.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 50920.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 85212.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 107601.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "983", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18602.04, "maximum": 39308.88, "estimated_discounted_cash": 175284.56, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26281.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20033.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19352.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18602.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31129.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39308.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4731.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1586.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5816.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1949.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6365.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2134.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4244.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1423.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4241.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1420.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4931.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1653.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3971.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1331.62, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4834.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1621.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12316.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12316.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4139.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4780.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1607.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21632", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4380.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3685.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1226.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5014.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1669.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8001.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2664.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2712.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 909.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE THYROID SURGERY", "code_information": [{"code": "60254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6061.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2024.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3528.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1172.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4355.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1452.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5266.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5266.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1753.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4546.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4546.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1412.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4756.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1586.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5568.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1858.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5597.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5597.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1866.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTENSV ORAL EVAL PROB FOCUS", "code_information": [{"code": "D0160", "type": "HCPCS"}], "standard_charges": [{"minimum": 162.64, "maximum": 162.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL BLEACHING HOME APP", "code_information": [{"code": "D9975", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.06, "maximum": 328.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 328.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 55.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRA AMBULANCE ATTENDANT", "code_information": [{"code": "A0424", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17610.08, "maximum": 37212.71, "estimated_discounted_cash": 134725.67, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23121.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18964.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18320.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17610.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29469.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37212.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35729.16, "maximum": 75501.02, "estimated_discounted_cash": 208936.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45832.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38478.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37171.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35729.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59791.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75501.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12757.7, "maximum": 26958.92, "estimated_discounted_cash": 134857.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15416.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13739.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13272.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12757.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21349.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26958.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION CORONAL REMNANTS", "code_information": [{"code": "D7111", "type": "HCPCS"}], "standard_charges": [{"minimum": 223.82, "maximum": 223.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 223.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION ERUPTED TOOTH/EXR", "code_information": [{"code": "D7140", "type": "HCPCS"}], "standard_charges": [{"minimum": 244.5, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2710.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 902.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3102.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1031.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION OF LENS", "code_information": [{"code": "66940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2841.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 944.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16658.27, "maximum": 35201.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18619.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17939.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17330.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16658.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27876.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35201.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL 2D PROJECT IMAGE", "code_information": [{"code": "D0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.78, "maximum": 56.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 74692.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 74692.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5666.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5624.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5406.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8805.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11118.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER ARCH", "code_information": [{"code": "D9972", "type": "HCPCS"}], "standard_charges": [{"minimum": 381.61, "maximum": 381.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9973", "type": "HCPCS"}], "standard_charges": [{"minimum": 245.52, "maximum": 245.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 245.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 372.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 142.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE CIRC/BA", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8122000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE DETECTION OF FOR/BDY", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "4900030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 95.53, "gross_charge": 638.0, "discounted_cash": 478.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 85.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 95.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE IOL ASPHERIC", "code_information": [{"code": "C1780", "type": "HCPCS"}, {"code": "8122039", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 380.25, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE MVMT ALYS W/O CALBRJ I&R", "code_information": [{"code": "615T", "type": "CPT"}], "standard_charges": [{"minimum": 350.06, "maximum": 350.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 350.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE SCLERAL SLEEVE IMP", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8122095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 194.0, "discounted_cash": 145.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SILIC STRIP IMP", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8122107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 227.0, "discounted_cash": 170.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SILICONE SP", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8122115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SPHERE PLSTC", "code_information": [{"code": "V2629", "type": "HCPCS"}, {"code": "8122114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 557.0, "discounted_cash": 417.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 562.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 672.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE TIRE/S", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8122125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 237.0, "discounted_cash": 177.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZETIMIBE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304875", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZETIMIBE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304875", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE COMMON VARIANTS", "code_information": [{"code": "81237", "type": "CPT"}], "standard_charges": [{"minimum": 157.86, "maximum": 665.29, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 176.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81236", "type": "CPT"}], "standard_charges": [{"minimum": 254.59, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 256.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 284.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (DHMT) device that augments a behavioral therapy plan, physician/other qualified health care profe", "code_information": [{"code": "G0554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.06, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), at time of initial implantation o", "code_information": [{"code": "930T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), separate from initial implantatio", "code_information": [{"code": "931T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2022.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Emboli detection without intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 227.0, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 227.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Emergency Room Emtalaemergency Medical Screening Services", "code_information": [{"code": "451", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 12.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Beyond Emtala Screening", "code_information": [{"code": "452", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 12.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Emergency Room, General", "code_information": [{"code": "450", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 12.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Other", "code_information": [{"code": "459", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 12.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Emergency Room, Urgent Care", "code_information": [{"code": "456", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 12.7, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components", "code_information": [{"code": "C9901", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 3848.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Endoskel posit rotat unit", "code_information": [{"code": "K1022", "type": "HCPCS"}], "standard_charges": [{"minimum": 3291.3, "maximum": 3291.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3291.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when perform", "code_information": [{"code": "884T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3848.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99337", "type": "CPT"}], "standard_charges": [{"minimum": 715.63, "maximum": 715.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 715.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 15 Minutes", "code_information": [{"code": "99334", "type": "CPT"}], "standard_charges": [{"minimum": 224.47, "maximum": 224.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 224.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 25 Minutes", "code_information": [{"code": "99335", "type": "CPT"}], "standard_charges": [{"minimum": 353.13, "maximum": 353.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Established Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 40 Minutes", "code_information": [{"code": "99336", "type": "CPT"}], "standard_charges": [{"minimum": 499.69, "maximum": 499.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 499.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Examination Of Bladder And Urethra With Mechanical Dilation And Drug Delivery For Narrowing Of Urethra Using An Endoscope", "code_information": [{"code": "499T", "type": "CPT"}], "standard_charges": [{"minimum": 360.34, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 360.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 10.1 to 20 cm", "code_information": [{"code": "49188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2431.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 20.1 to 30 cm", "code_information": [{"code": "49189", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2828.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less", "code_information": [{"code": "49186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1594.4, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5.1 to 10 cm", "code_information": [{"code": "49187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2034.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); greater than 30 cm", "code_information": [{"code": "49190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3487.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3487.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Extra-Corporeal Shock Wave Therapy, General", "code_information": [{"code": "790", "type": "RC"}], "standard_charges": [{"minimum": 0.2, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 10.1, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "IMPERIAL MEDICARE ADVANTAGE", "plan_name": "IMPERIAL MEDICARE ADVANTAGE", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}, {"payer_name": "IMPERIAL MEDICARE ADVANTAGE", "plan_name": "IMPERIAL MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F EMB TRNS CANC CASE RATE", "code_information": [{"code": "S4018", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F18 FDG", "code_information": [{"code": "A9552", "type": "HCPCS"}], "standard_charges": [{"minimum": 1361.88, "maximum": 1361.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1361.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F2 GENE ANLS VARIANT", "code_information": [{"code": "81240", "type": "CPT"}, {"code": "7251240", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 249.16, "gross_charge": 659.0, "discounted_cash": 494.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 95.7, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 111.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 59.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F5 LEIDEN VARIANT", "code_information": [{"code": "81241", "type": "CPT"}, {"code": "7259207", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 278.29, "gross_charge": 859.0, "discounted_cash": 644.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 118.85, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 137.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 540.0, "maximum": 2275.8, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 543.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 603.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2275.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FABRIC WRAPPING OF ANEURYSM", "code_information": [{"code": "M0301", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FABRICATION ATHLETIC GUARD", "code_information": [{"code": "D9941", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.07, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAC 8/VWF CMPL PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}, {"code": "5320638", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.56, "maximum": 4.56, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACE BONE GRAFT", "code_information": [{"code": "21210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2772.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1042.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2120.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1042.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL AUGMENTATION IMPLANT", "code_information": [{"code": "D5925", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 2VW MAX", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "4900140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 97.39, "gross_charge": 1625.0, "discounted_cash": 1218.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 61.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 97.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL BONES 3VW MIN", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "4900150", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 141.45, "gross_charge": 2396.0, "discounted_cash": 1797.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE COMPLETE", "code_information": [{"code": "D5912", "type": "HCPCS"}], "standard_charges": [{"minimum": 624.4, "maximum": 624.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 624.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE SECTIONAL", "code_information": [{"code": "D5911", "type": "HCPCS"}], "standard_charges": [{"minimum": 416.21, "maximum": 416.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 416.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 88.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL PROSTHESIS", "code_information": [{"code": "D5919", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACIAL REPLACEMENT", "code_information": [{"code": "D5929", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACTOR 8 RECOM PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7192", "type": "HCPCS"}, {"code": "5320693", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.74, "maximum": 5.74, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR 9 CMPLX PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7194", "type": "HCPCS"}, {"code": "5320697", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.09, "maximum": 6.09, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR 9 RECOM PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7195", "type": "HCPCS"}, {"code": "5320698", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.64, "maximum": 6.64, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR", "code_information": [{"code": "85335", "type": "CPT"}, {"code": "7251292", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.82, "gross_charge": 510.0, "discounted_cash": 382.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX ALPROLIX RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7201", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.14, "maximum": 13.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX IDELVION INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7202", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.74, "maximum": 18.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX NON-RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7193", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.01, "maximum": 5.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMB GLY REBINYN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7203", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.72, "maximum": 16.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINAN RIXUBIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7200", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.88, "maximum": 5.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7189", "type": "HCPCS"}, {"code": "5320639", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.21, "maximum": 9.21, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA-JNCW PER 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7212", "type": "HCPCS"}, {"code": "5320587", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.7, "maximum": 7.7, "gross_charge": 7.0, "discounted_cash": 5.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7190", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.9, "maximum": 3.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII (PORCINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7191", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.34, "maximum": 8.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII FC FUSION RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7205", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.3, "maximum": 8.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII NUWIQ RECOMB 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7209", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.86, "maximum": 4.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII PEGYLATED RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7207", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.51, "maximum": 7.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB NOVOEIGHT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7182", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.08, "maximum": 5.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB OBIZUR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7188", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.22, "maximum": 12.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII ANTI-HEM FACTOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7180", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.7, "maximum": 36.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII RECOMB A-SUBUNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7181", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.99, "maximum": 64.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTR VIII RISTO CO-FCTR", "code_information": [{"code": "85245", "type": "CPT"}, {"code": "7255245", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 87.01, "gross_charge": 887.0, "discounted_cash": 665.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 44.56, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL ELASTASE EL1 QN/2", "code_information": [{"code": "82653", "type": "CPT"}, {"code": "7258270", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.8, "maximum": 87.13, "gross_charge": 584.0, "discounted_cash": 438.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA PREP INSTIL", "code_information": [{"code": "G0455", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 159.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEEDING AID", "code_information": [{"code": "D5951", "type": "HCPCS"}], "standard_charges": [{"minimum": 3123.23, "maximum": 3123.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3123.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 148.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 49.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 835.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELBAMATE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304915", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELBAMATE 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304915", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELODIPINE 5MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304920", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FELODIPINE 5MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304920", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM AUGMENT COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9850.0, "discounted_cash": 7387.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM CEMENT REST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8174600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17966.0, "discounted_cash": 13474.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 88399.0, "discounted_cash": 66299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM COMPONENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 77754.0, "discounted_cash": 58315.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38450.0, "discounted_cash": 28837.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8132535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 55759.0, "discounted_cash": 41819.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/ARTHR & US", "code_information": [{"code": "C7534", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POP REVASC W/STENT & US", "code_information": [{"code": "C7535", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 19719.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2106.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8343.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9854.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8343.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 49150.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1564.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2534.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3308.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2534.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 25572.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2520.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10703.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 12585.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10703.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 32637.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1824.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7764.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9119.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7764.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15056.37, "maximum": 31816.34, "estimated_discounted_cash": 196992.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15800.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16214.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15664.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15056.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25196.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31816.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 826.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.52, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FEMUR 1 VW", "code_information": [{"code": "73551", "type": "CPT"}, {"code": "4903552", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 274.36, "gross_charge": 950.0, "discounted_cash": 712.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 246.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 274.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR 2 VIEWS MIN", "code_information": [{"code": "73552", "type": "CPT"}, {"code": "4903551", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 274.36, "gross_charge": 1323.0, "discounted_cash": 992.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 92.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 246.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 274.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR MOD KNEE OSTEOREMEDS CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35943.0, "discounted_cash": 26957.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FENOFIBRATE 145MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304938", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENOFIBRATE 145MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304938", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENOFIBRATE 48MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304933", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENOFIBRATE 48MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": 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"standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERROUS SULF 300MG/5MLLQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315207", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FERROUS SULF 300MG/5MLLQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315207", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FERROUS SULF15/.6 50MLLQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315383", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FERROUS SULF15/.6 50MLLQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315383", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FERROUS SULFATE 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5305044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FERROUS SULFATE 325MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5305044", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, ESRD USE", "code_information": [{"code": "Q0139", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, NON-ESRD", "code_information": [{"code": "Q0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 546.98, "maximum": 3015.44, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 607.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3015.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFIL W/O NST", "code_information": [{"code": "76819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 259.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 162.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 233.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 259.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 180.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 332.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 174.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 112.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 299.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 332.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 83.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2879.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1137.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 751.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2879.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1137.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 751.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 727.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}, {"code": "4102731", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 244.31, "gross_charge": 1584.0, "discounted_cash": 1188.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 125.09, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 74.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}, {"code": "4172731", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 244.31, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 125.09, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 74.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}, {"code": "7252731", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 244.31, "gross_charge": 1295.0, "discounted_cash": 971.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 125.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 67.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 74.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1113.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR/INTERPRET ONLY", "code_information": [{"code": "59051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL RBC ROSETTE", "code_information": [{"code": "85461", "type": "CPT"}, {"code": "4102720", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.5, "gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL RBC ROSETTE", "code_information": [{"code": "85461", "type": "CPT"}, {"code": "4175461", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.5, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 134.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1876.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FFP THAW EA UNIT", "code_information": [{"code": "86927", "type": "CPT"}, {"code": "4176928", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.1, "maximum": 134.24, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8868.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8868.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2967.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FIDAXOMICIN 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2043.0, "discounted_cash": 1532.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIDAXOMICIN 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305069", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2043.0, "discounted_cash": 1532.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILGRASTIM G-CSF 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}, {"code": "5320783", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.74, "maximum": 3.74, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILGRASTIM G-CSF 1MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}, {"code": "5320783", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.74, "maximum": 3.74, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILLER BN VOID CHRONOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11876.0, "discounted_cash": 8907.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2474.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 818.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FILTER VENA CAVA", "code_information": [{"code": "C1880", "type": "HCPCS"}, {"code": "8240143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45672.0, "discounted_cash": 34254.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 112.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3005.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 998.89, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FINASTERIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINASTERIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINASTERIDE, 5 MG", "code_information": [{"code": "S0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3330.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1106.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4323.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1440.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER(S) 2 VIEWS", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "4903140", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 114.89, "gross_charge": 1700.0, "discounted_cash": 1275.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 48.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 100.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 112.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 114.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR & COLOSTOMY", "code_information": [{"code": "57307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3947.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1315.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR TRANSPERINE", "code_information": [{"code": "57308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2434.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 813.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FISTULA-SINUS TRCT STDY", "code_information": [{"code": "76080", "type": "CPT"}, {"code": "4916082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 482.89, "gross_charge": 17722.0, "discounted_cash": 13291.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 104.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 47.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 152.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 169.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"minimum": 26.82, "maximum": 65.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"minimum": 26.82, "maximum": 88.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"minimum": 17.88, "maximum": 145.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"minimum": 17.88, "maximum": 126.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"minimum": 17.52, "maximum": 154.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG C-LENS KERATOCONUS 1ST", "code_information": [{"code": "92072", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 338.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 338.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"minimum": 50.71, "maximum": 50.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"minimum": 78.55, "maximum": 78.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 171.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 700.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 832.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 700.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIX MOD GLENOID ZIMMER CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4012964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3375.0, "discounted_cash": 2531.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FIX PARTIAL DENTURE SECTION", "code_information": [{"code": "D9120", "type": "HCPCS"}], "standard_charges": [{"minimum": 238.2, "maximum": 238.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION OF ANKLE JOINT", "code_information": [{"code": "27860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 601.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF KNEE JOINT", "code_information": [{"code": "27570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 11806.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 569.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee 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"standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3565.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1197.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXED APPLIANCE THERAPY HABT", "code_information": [{"code": "D8220", "type": "HCPCS"}], "standard_charges": [{"minimum": 1444.83, "maximum": 1444.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1444.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED PARTIAL REPAIR", "code_information": [{"code": "D6980", "type": "HCPCS"}], "standard_charges": [{"minimum": 436.88, "maximum": 436.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 436.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED PROSTHODONTIC PROC", "code_information": [{"code": "D6999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEBOGAMMA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1572", "type": "HCPCS"}], "standard_charges": [{"minimum": 212.85, "maximum": 212.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 212.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}, {"code": "7250089", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.82, "maximum": 70.7, "gross_charge": 410.0, "discounted_cash": 307.5, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305085", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305085", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305084", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305084", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE ORAL CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLECAINIDE ORAL CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315215", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLI SHP PRF 15X24 SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021047", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 187.0, "discounted_cash": 140.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLI SHP PRF 15X24 SQ CM", "code_information": [{"code": 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"gross_charge": 295.0, "discounted_cash": 221.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIA HYD 16X20 PER SQCM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021041", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 295.0, "discounted_cash": 221.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIAB 13X22 PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021038", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIAB 13X22 PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021038", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABL 8X16CM PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021039", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 299.0, "discounted_cash": 224.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABL 8X16CM PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021039", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 299.0, "discounted_cash": 224.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABL 8X20CM PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021044", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 17035.0, "discounted_cash": 12776.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": 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[{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD PLIABLE PERF PER SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}, {"code": "4021061", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 116.57, "maximum": 6955.0, "gross_charge": 225.0, "discounted_cash": 168.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW", "code_information": [{"code": "24330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2648.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 890.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2889.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 971.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLORBETABEN F18 DIAGNOSTIC", "code_information": [{"code": "Q9983", "type": "HCPCS"}], "standard_charges": [{"minimum": 12744.48, "maximum": 12744.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12744.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLORBETAPIR F18", "code_information": [{"code": "A9586", "type": "HCPCS"}], "standard_charges": [{"minimum": 12355.47, "maximum": 12355.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12355.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLORTAUCIPIR INJ 1 MILLICURI", "code_information": [{"code": "A9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1593.06, "maximum": 1593.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1593.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOTUFOLASTAT F18 DIAG 1 MCI", "code_information": [{"code": "A9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 2658.32, "maximum": 2658.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2658.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO ADD MARKER", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "7078185", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.83, "gross_charge": 456.0, "discounted_cash": 342.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 37.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO ADD MARKER", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "7258185", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.83, "gross_charge": 497.0, "discounted_cash": 372.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 37.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOW CYTO ADD MARKER", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "7270063", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.83, "gross_charge": 456.0, "discounted_cash": 342.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 33.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 37.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20.73, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 62.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 283.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 94.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee 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98.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VAC>3Y FLUZONE IM IJ", "code_information": [{"code": "Q2038", "type": "HCPCS"}, {"code": "5320704", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 37.55, "maximum": 37.55, "gross_charge": 197.0, "discounted_cash": 147.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV3 NO PRESERV ID", "code_information": [{"code": "90654", "type": "CPT"}], "standard_charges": [{"minimum": 71.76, "maximum": 71.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.76, "methodology": 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"standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCONAZ 40MG/ML 5MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315221", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCONAZ PER200MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1450", "type": "HCPCS"}, {"code": "5320677", "type": 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{"description": "FLUCONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUCONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305097", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee 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"methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 322.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 184.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 310.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 184.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLULAVAL VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.74, "maximum": 29.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUMAZENIL .1MG/ML 5MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5320681", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 667.0, "discounted_cash": 500.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUNISOLIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.57, "maximum": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "estimated_discounted_cash": 14539.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%15GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335498", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 120.0, "discounted_cash": 90.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%15GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335498", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 120.0, "discounted_cash": 90.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%15GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335503", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%15GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335503", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 182.0, "discounted_cash": 136.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%30GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335513", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE .05%30GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5335513", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 153.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 439.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 439.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 139.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN STRIP 1 EACH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330968", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 828.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 828.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 327.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT AB TITER EA", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "7253026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT AB TITER EA/2", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "7254218", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 532.0, "discounted_cash": 399.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT AB TITER EA/3", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "7254219", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCNT SCRN EA AB", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7258627", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 202.0, "discounted_cash": 151.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCNT SCRN EA AB/2", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7256254", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 1027.0, "discounted_cash": 770.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 2991.0, "discounted_cash": 2243.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330992", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLURBIPROFEN.03%2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5330992", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUT/SALM 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"type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 927.0, "discounted_cash": 695.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTICASONE .05MG16GM SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5330995", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 927.0, "discounted_cash": 695.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTICASONE110MCGG DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331009", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTICASONE110MCGG DS IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331009", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUVIRIN VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2037", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.1, "maximum": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUVOXAMINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305235", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUVOXAMINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305235", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 51.34, "maximum": 216.35, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 73.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 34.48, "maximum": 170.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 230.13, "maximum": 1853.15, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 764.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1853.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 344.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee 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[{"gross_charge": 5180.0, "discounted_cash": 3885.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 391.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 259.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN 1ST LES", "code_information": [{"code": "10007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 244.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN 1ST LES", "code_information": [{"code": "10021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 122.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 156.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST LES", "code_information": [{"code": "10005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4752.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 180.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 73.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOAM DRG >16<=48 SQ IN W/BDR", "code_information": [{"code": "A6213", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.08, "maximum": 52.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "4102746", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.76, "gross_charge": 630.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "4122746", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.76, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "4152746", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.76, "gross_charge": 175.0, "discounted_cash": 131.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "4172746", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.76, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLIC ACID PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1808", "type": "HCPCS"}, {"code": "5320818", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.23, "discounted_cash": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLIC ACID PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1808", "type": "HCPCS"}, {"code": "5320818", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.23, "discounted_cash": 0.17, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLIC ACID RBC", "code_information": [{"code": "82747", "type": "CPT"}, {"code": "7252747", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.95, "gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 33.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLICLE STIMLAT HORMONE", "code_information": [{"code": "83001", "type": "CPT"}, {"code": "7253001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.47, "gross_charge": 181.0, "discounted_cash": 135.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP SURGERY OF EYE", "code_information": [{"code": "66250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2017.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 204.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 896.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 204.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOLLOWUP EVAL OF FOOT PT LOP", "code_information": [{"code": "G0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 72.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOMEPIZOLE PER 15MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1451", "type": "HCPCS"}, {"code": "5320731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 49.8, "maximum": 49.8, "gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOMEPIZOLE PER 15MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1451", "type": "HCPCS"}, {"code": "5320731", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 49.8, "maximum": 49.8, "gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FONDAPARINUX PER.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1652", "type": "HCPCS"}, {"code": "5320766", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4.15, "maximum": 4.15, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FONDAPARINUX PER.5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1652", "type": "HCPCS"}, {"code": "5320766", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.15, "maximum": 4.15, "gross_charge": 108.0, "discounted_cash": 81.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOD THICKENER ORAL", "code_information": [{"code": "B4100", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.41, "maximum": 3.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 2 VIEWS", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "4903620", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.01, "gross_charge": 2377.0, "discounted_cash": 1782.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT 3 VIEWS MINIMUM", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "4903630", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.4, "gross_charge": 2576.0, "discounted_cash": 1932.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 55.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 97.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 108.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20286.43, "maximum": 42868.23, "estimated_discounted_cash": 132144.38, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22860.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21847.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21105.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20286.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33948.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42868.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30291.81, "maximum": 64011.09, "estimated_discounted_cash": 58376.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34001.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32622.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31514.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30291.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50691.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64011.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18173.37, "maximum": 41116.08, "estimated_discounted_cash": 96313.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18173.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20954.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20242.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19457.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32560.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41116.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOREARM 2 VIEWS", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "4903091", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.67, "gross_charge": 2370.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 84.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3635.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1369.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 359.72, "maximum": 2131.25, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 359.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 399.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2131.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.48, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL 20MCG/2ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331017", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL 20MCG/2ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331017", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7640", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.34, "maximum": 8.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL FUMARATE, INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7606", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.56, "maximum": 15.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSAPREPITANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1453", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.52, "maximum": 0.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSCARNET PER 1000MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1455", "type": "HCPCS"}, {"code": "5320743", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 261.53, "maximum": 261.53, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSCARNET PER 1000MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1455", "type": "HCPCS"}, {"code": "5320743", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 261.53, "maximum": 261.53, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSFOMYCIN 3GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSFOMYCIN 3GM PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305239", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN PER 50MG IJ", "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "5320749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 12.06, "maximum": 12.06, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN PER 50MG IJ", "code_information": [{"code": "Q2009", "type": "HCPCS"}, {"code": "5320749", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.06, "maximum": 12.06, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FR FRZ PLASMA DONOR RETESTED", "code_information": [{"code": "P9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 220.34, "maximum": 220.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.08, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 59.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE ASSESSMENT VIA DXA", "code_information": [{"code": "77086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 100.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 97.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 93.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [{"code": "562", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15463.35, "maximum": 32676.36, "estimated_discounted_cash": 76880.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19968.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16653.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16087.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15463.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25877.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16264.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20537.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17014.25, "maximum": 35953.63, "estimated_discounted_cash": 95325.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21117.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18323.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17700.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17014.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28472.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35953.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8748.6, "maximum": 18487.1, "estimated_discounted_cash": 95596.93, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11063.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9421.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9101.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8748.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14640.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18487.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13913.55, "maximum": 29401.39, "estimated_discounted_cash": 37888.56, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18080.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14984.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14475.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13913.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23283.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29401.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8764.88, "maximum": 18521.5, "estimated_discounted_cash": 62507.93, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10491.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9439.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9118.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8764.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14667.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18521.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNEY STONE", "code_information": [{"code": "50590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 25650.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8420.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7967.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2088.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 898.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENS AB", "code_information": [{"code": "86668", "type": "CPT"}, {"code": "7258666", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.71, "gross_charge": 242.0, "discounted_cash": 181.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8199.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8199.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2742.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3585.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8284.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8284.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2770.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6032.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6032.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8233.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8233.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2753.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5744.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1921.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3950.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1323.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FRENULOPLASTY", "code_information": [{"code": "D7963", "type": "HCPCS"}], "standard_charges": [{"minimum": 790.12, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 790.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 714.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 240.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 30.46, "maximum": 346.34, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 346.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 55.62, "maximum": 408.09, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 55.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 61.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 408.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 41.64, "maximum": 306.36, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 41.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN IVF CASE RATE", "code_information": [{"code": "S4016", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FROZEN PLASMA, POOLED, SD", "code_information": [{"code": "P9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 229.32, "maximum": 229.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTH GR F/C/C/M/N/AX/G/H/F EA", "code_information": [{"code": "15241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 386.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GR FR F/C/C/M/N/AX/G/H/F", "code_information": [{"code": "15240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2907.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1136.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L 20 SQCM/<", "code_information": [{"code": "15260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3085.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1224.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 488.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L 20 SQ CM/<", "code_information": [{"code": "15220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2228.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 939.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L EACH ADDL", "code_information": [{"code": "15221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 248.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 63.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 63.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK 20 SQ CM/<", "code_information": [{"code": "15200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2455.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1023.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE 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"standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL ANEUP DNA SEQ CMPR ALYS", "code_information": [{"code": "341U", "type": "CPT"}], "standard_charges": [{"minimum": 1294.44, "maximum": 7207.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1294.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1438.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7207.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1710.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 517.07, "maximum": 2879.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 517.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 574.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY TRSMY DNA SEQ", "code_information": [{"code": "327U", "type": "CPT"}], "standard_charges": [{"minimum": 546.98, "maximum": 3015.44, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 546.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 607.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3015.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 38.84, "maximum": 5641.59, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 38.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5641.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1338.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 62.57, "maximum": 263.69, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 64.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 71.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 41.52, "maximum": 582.23, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 138.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 49.99, "maximum": 210.66, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 58.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 65.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 41.41, "maximum": 205.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 41.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 329.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 329.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL LENGTH SURG STOCKING", "code_information": [{"code": "A4510", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.05, "maximum": 29.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH DEBRIDEMENT", "code_information": [{"code": "D4355", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.52, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 204.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 230.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 84.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 67.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 160.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 178.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 52.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 52401.78, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 52401.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2507.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2488.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2391.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3896.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4920.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77845.31, "maximum": 164498.7, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 78410.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 83834.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80986.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 77845.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 130270.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 164498.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC", "code_information": [{"code": "929", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34009.87, "maximum": 73865.83, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34009.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37644.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 36366.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34955.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58496.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73865.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22943.26, "maximum": 50697.9, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22943.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25837.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24959.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23991.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40148.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50697.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL BRAIN MAPPING", "code_information": [{"code": "96020", "type": "CPT"}], "standard_charges": [{"minimum": 341.9, "maximum": 341.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256671", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.46, "gross_charge": 573.0, "discounted_cash": 429.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES/2", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "7256672", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.46, "gross_charge": 249.0, "discounted_cash": 186.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNGUS ISOLATION CULTURE", "code_information": [{"code": "87102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305279", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305279", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305283", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305283", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315248", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 40MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315248", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305287", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE 80MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305287", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1940", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.17, "maximum": 2.17, "estimated_discounted_cash": 1260.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUROSEMIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "5320822", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.09, "discounted_cash": 0.07, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1938", "type": "HCPCS"}, {"code": "5320822", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.09, "discounted_cash": 0.07, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8139.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8139.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2718.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8939.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8939.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2988.89, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11671.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3895.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4997.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4997.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1674.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5020.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1678.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4191.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1403.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4759.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4759.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1593.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5343.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5343.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1788.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE HAND BONES WITH GRAFT", "code_information": [{"code": "25825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2925.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 981.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 5519.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5519.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10923.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10923.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3654.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6045.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2023.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3986.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1334.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4730.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4730.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1584.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4909.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4909.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1643.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 819.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION 2 OR MORE 3D IMAGES", "code_information": [{"code": "D0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.64, "maximum": 102.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF ANKLE JOINT OPEN", "code_information": [{"code": "27870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3692.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1238.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 11709.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2119.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 209.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 944.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 209.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1235.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 615.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2108.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 204.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 934.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 204.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3068.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4518.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4518.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1512.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3634.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JNT ADD-ON", "code_information": [{"code": "26861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 367.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINT", "code_information": [{"code": "26860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 24423.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2261.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 749.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JOINTS", "code_information": [{"code": "C7506", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2435.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 809.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2405.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4463.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1497.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 29597.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3444.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1159.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2860.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 959.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 33880.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2664.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 894.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2848.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 960.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 73203.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2268.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1001.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND BONES", "code_information": [{"code": "25820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2397.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 804.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND JOINT", "code_information": [{"code": "26843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2882.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 956.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5388.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1802.52, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE", "code_information": [{"code": "26850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 899.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINT", "code_information": [{"code": "26516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2739.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3187.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1060.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3227.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1073.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE WITH GRAFT", "code_information": [{"code": "26852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3072.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1023.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9470.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3170.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2913.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 978.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3842.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1288.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3687.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1236.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4875.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4875.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1633.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4753.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4753.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1593.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2551.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 858.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2381.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 800.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF THUMB", "code_information": [{"code": "26841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2857.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 946.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TIBIOFIBULAR JOINT", "code_information": [{"code": "27871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2542.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 850.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TOES", "code_information": [{"code": "28280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1272.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5102.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5102.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1710.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4444.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4444.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1489.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4178.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1400.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4097.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1370.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FUSION OF WRIST JOINT", "code_information": [{"code": "25800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2694.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION RADIOULNAR JNT/ULNA", "code_information": [{"code": "25830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3780.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1257.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3673.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1234.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF FINGER JOINT", "code_information": [{"code": "26862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 31653.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2827.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 939.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF HAND JOINT", "code_information": [{"code": "26844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3166.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1053.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3118.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1047.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3192.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 892.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case 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"standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 248.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 276.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FXN GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81289", "type": "CPT"}], "standard_charges": [{"minimum": 166.68, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 167.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 186.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FY GNOTYP ACKR1 EXONS 1-2", "code_information": [{"code": "187U", "type": "CPT"}], "standard_charges": [{"minimum": 189.1, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 189.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "First 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (DMHT) device that augments a behavioral therapy plan, physician/other qualified health care professional ti", "code_information": [{"code": "G0553", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.0, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR 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"standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5983.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2004.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6544.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2192.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1501.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1057.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1350.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1501.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1141.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1991.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1334.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1792.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1991.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1307.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 421.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING STUDY", "code_information": [{"code": "78264", "type": "CPT"}, {"code": "5208276", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1140.82, "gross_charge": 10390.0, "discounted_cash": 7792.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 487.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 431.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1026.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1140.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 964.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC MANOMETRY STUDY", "code_information": [{"code": "91020", "type": "CPT"}, {"code": "5071078", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "gross_charge": 4854.0, "discounted_cash": 3640.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 745.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 995.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 460.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 376.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 896.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 995.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN", "code_information": [{"code": "82941", "type": "CPT"}, {"code": "7252941", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 66.87, "gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 986.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 363.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 887.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 986.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 706.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 230.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10643.54, "maximum": 22491.37, "estimated_discounted_cash": 99452.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14599.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11462.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11073.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10643.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17811.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22491.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19839.28, "maximum": 41923.35, "estimated_discounted_cash": 140041.63, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25896.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21365.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20639.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19839.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33200.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41923.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6841.73, "maximum": 14457.59, "estimated_discounted_cash": 64124.28, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9871.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7368.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7117.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6841.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11449.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14457.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8571.7, "maximum": 18113.27, "estimated_discounted_cash": 57607.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12699.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9231.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8917.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8571.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14344.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18113.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16027.71, "maximum": 33868.93, "estimated_discounted_cash": 120908.08, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23456.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17260.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16674.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16027.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26821.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33868.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5904.03, "maximum": 12476.1, "estimated_discounted_cash": 55601.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8790.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6358.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6142.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5904.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9880.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12476.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8036.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2684.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9742.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3265.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7089.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2379.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4656.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1560.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1274.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 796.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 377.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1147.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1274.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 729.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SNGL", "code_information": [{"code": "78472", "type": "CPT"}, {"code": "5208402", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 977.28, "gross_charge": 5632.0, "discounted_cash": 4224.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 573.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 314.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 879.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 977.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 600.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAUZE <= 16 SQ IN WATER/SAL", "code_information": [{"code": "A6228", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.86, "maximum": 4.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAUZE > 48 SQ IN WATER/SALNE", "code_information": [{"code": "A6230", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GBA GENE", "code_information": [{"code": "81251", "type": "CPT"}], "standard_charges": [{"minimum": 42.53, "maximum": 179.22, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "4107592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 688.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "4127592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "4157592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "4177592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GC DNA AMP PROBE", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "7257592", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 229.0, "discounted_cash": 171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"type": "HCPCS"}], "standard_charges": [{"minimum": 286.79, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 286.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINGIVECTOMY/PLASTY 4 OR MOR", "code_information": [{"code": "D4210", "type": "HCPCS"}], "standard_charges": [{"minimum": 776.81, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 776.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINGIVECTOMY/PLASTY REST", "code_information": [{"code": "D4212", "type": "HCPCS"}], "standard_charges": [{"minimum": 286.79, "maximum": 286.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 286.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GINTRO AGILIS STRB NPEEL", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8241099", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8360.0, "discounted_cash": 6270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GINTRO CPS DIRECT", "code_information": [{"code": "C1893", "type": "HCPCS"}, {"code": "8241101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5086.0, "discounted_cash": 3814.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GINTRO SWARTZ", "code_information": [{"code": "C1893", "type": "HCPCS"}, {"code": "8241178", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2567.0, "discounted_cash": 1925.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GJB2 FULL GENE SEQUENCE", "code_information": [{"code": "81252", "type": "CPT"}, {"code": "7251252", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 91.01, "maximum": 383.55, "gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 96.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 91.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 37.99, "maximum": 233.35, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 37.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GJB6 COMMON VARIANT", "code_information": [{"code": "81254", "type": "CPT"}, {"code": "7251254", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 31.5, "maximum": 132.76, "gross_charge": 1495.0, "discounted_cash": 1121.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 57.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 63.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLASSES AIR CONDUCTION", "code_information": [{"code": "V5070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1013.57, "maximum": 1013.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1013.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLASSES BINAURAL HEARING AID", "code_information": [{"code": "V5150", "type": "HCPCS"}], "standard_charges": [{"minimum": 4218.92, "maximum": 4218.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4218.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLASSES BONE CONDUCTION", "code_information": [{"code": "V5080", "type": "HCPCS"}], "standard_charges": [{"minimum": 2546.62, "maximum": 2546.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2546.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLASSIA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.3, "maximum": 20.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0117", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 232.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SCRN HGH RISK DIREC", "code_information": [{"code": "G0118", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3184.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1056.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3183.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1055.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3576.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1186.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3966.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1318.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLEN PEG/KEEL/HYBRD TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11355.0, "discounted_cash": 8516.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENIOD PEG KEEL HYB STRY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4932.0, "discounted_cash": 3699.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID AUGM TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25807.0, "discounted_cash": 19355.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID GLENOSPHERE TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18580.0, "discounted_cash": 13935.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PEG KEEL HYB DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6648.0, "discounted_cash": 4986.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7400.0, "discounted_cash": 5550.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOSPHERE ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23750.0, "discounted_cash": 17812.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIADIN AB", "code_information": [{"code": "86258", "type": "CPT"}, {"code": "7253508", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.92, "maximum": 45.71, "gross_charge": 215.0, "discounted_cash": 161.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305320", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305321", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305321", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305322", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIMEPIRIDE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305322", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIPIZIDE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305347", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIPIZIDE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305347", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIPIZIDE 2.5MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": 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"code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305345", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIPIZIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305345", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLOBAL ESWL KIDNEY", "code_information": 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[{"minimum": 1.0, "maximum": 45.71, "gross_charge": 1012.0, "discounted_cash": 759.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCAGON PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1610", "type": "HCPCS"}, {"code": "5320898", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 714.48, "maximum": 714.48, "gross_charge": 865.0, "discounted_cash": 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SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021503", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 1902.0, "discounted_cash": 1426.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 2X3CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021509", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 1310.0, "discounted_cash": 982.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 2X3CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021509", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 1310.0, "discounted_cash": 982.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 3X3CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021510", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 989.0, "discounted_cash": 741.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 3X3CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021510", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 989.0, "discounted_cash": 741.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 5X5CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021508", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 825.0, "discounted_cash": 618.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIXPL PRIME 5X5CM PER SQ CM", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "4021508", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 517.08, "maximum": 517.08, "gross_charge": 825.0, "discounted_cash": 618.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3384.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1123.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT REPAIR OF SPINE DEFECT", "code_information": [{"code": "63710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3964.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1332.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFT TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8151555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17889.0, "discounted_cash": 13416.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT THORAFLEX HYBRID ANTEFLO", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4021709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 377999.0, "discounted_cash": 283499.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTJACKET PER SQ CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "4032506", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 263.99, "maximum": 263.99, "gross_charge": 2045.0, "discounted_cash": 1533.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET PER SQ CM", "code_information": [{"code": "Q4107", "type": "HCPCS"}, {"code": "4032506", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 263.99, "maximum": 263.99, "gross_charge": 2045.0, "discounted_cash": 1533.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET XPRESS", "code_information": [{"code": "Q4113", "type": "HCPCS"}], "standard_charges": [{"minimum": 3487.85, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3487.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4107205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 324.0, "discounted_cash": 243.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4127205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4157205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "7257205", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 159.0, "discounted_cash": 119.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR/2", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4107209", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAM STAIN SMEAR/2", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "4171013", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON 1MG", "code_information": [{"code": "S0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 220.37, "maximum": 220.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL 1 MG ORAL", "code_information": [{"code": "Q0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.55, "maximum": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1626", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.45, "maximum": 1.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANULOCYTES, PHERESIS UNIT", "code_information": [{"code": "P9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 5759.59, "maximum": 5759.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5759.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAVLEE JET WASHER", "code_information": [{"code": "A4470", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.74, "maximum": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11967.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11967.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4000.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1833.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 731.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1871.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 749.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 534.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1755.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 589.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFT AAA AFX 2PC CAP ENDOLOGX", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 129073.0, "discounted_cash": 96804.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT AAA MAIN BODY", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4021483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30368.0, "discounted_cash": 22776.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT AAA STENT", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203321.0, "discounted_cash": 152490.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ALLOMAX 10X10", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4021489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20611.0, "discounted_cash": 15458.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT AORTIC EXTENDER", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26088.0, "discounted_cash": 19566.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT AORTIC VALVED", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 53385.0, "discounted_cash": 40038.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT AORTOILIAC ARTERY", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4021701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 223348.0, "discounted_cash": 167511.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT BONE AUGMENT INJECT", "code_information": [{"code": "C1734", "type": "HCPCS"}, {"code": "4028838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32961.0, "discounted_cash": 24720.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT CNTRLTRL LEG", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41820.0, "discounted_cash": 31365.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT CORTICAL FIBER INCITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4021707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20653.0, "discounted_cash": 15489.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT CV PLEDGET", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 97.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT DURAMATRIX ONLAY", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18602.0, "discounted_cash": 13951.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT DVF WOVN HEMASHIELD", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8246550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15144.0, "discounted_cash": 11358.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDO THOR PROX TPR", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14846.0, "discounted_cash": 11134.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOV 2 PROX INTRNL", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 113585.0, "discounted_cash": 85188.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOV AAA MAIN BODY", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 163582.0, "discounted_cash": 122686.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOV DSTL BIFURCTD", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32434.0, "discounted_cash": 24325.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOV THORC PRX CMP", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160051.0, "discounted_cash": 120038.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOVAS TAA PROXML", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4021496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 112545.0, "discounted_cash": 84408.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOVS AAA CONVERTR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 67118.0, "discounted_cash": 50338.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDOVS THORAC DISTAL EXTN", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171080.0, "discounted_cash": 128310.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ENDV BF MN BDY ZTRK", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84744.0, "discounted_cash": 63558.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT FELT LO POROSITY", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8174711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT FEMORAL ARTERY", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4021498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66395.0, "discounted_cash": 49796.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT ILIAC LEG AAA ZENTH", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18891.0, "discounted_cash": 14168.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT IPSLTRL LEG", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41820.0, "discounted_cash": 31365.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT KPTCH FINES UT HEMA", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8246560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1003.0, "discounted_cash": 752.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT MESH MARLX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8142080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2971.0, "discounted_cash": 2228.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT MESH PROLN", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8142090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2971.0, "discounted_cash": 2228.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT NERVE AVANCE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4021702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 77443.0, "discounted_cash": 58082.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT OCULAR AMNIO MEMBRN", "code_information": [{"code": "V2790", "type": "HCPCS"}, {"code": "8122167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 34849.0, "gross_charge": 34849.0, "discounted_cash": 26136.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34849.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRFT PARASTOMAL REINFORC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4021704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14695.0, "discounted_cash": 11021.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT PERICARDIAL", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9161.0, "discounted_cash": 6870.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT PTCH", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8142125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 33260.0, "discounted_cash": 24945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT PV BYP DISTAFLO", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20104.0, "discounted_cash": 15078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS UP TO 60CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 97529.0, "discounted_cash": 73146.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT SAPHNOUS UP TO 80CM", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "8141771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72836.0, "discounted_cash": 54627.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT STNT AAA BIFURCATED", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45207.0, "discounted_cash": 33905.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GRFT STNT ABD ALTO CAP 3PC CSE", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4028443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 170326.0, "discounted_cash": 127744.5, "setting": 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"facility"}]}, {"description": "GUIDEWIRE II", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8240163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 811.0, "discounted_cash": 608.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE III", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8240167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1534.0, "discounted_cash": 1150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE IV", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8240161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3831.0, "discounted_cash": 2873.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE V", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5568.0, "discounted_cash": 4176.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUM GRAFT", "code_information": [{"code": "41870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1119.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2299.0, "discounted_cash": 1724.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.0, "discounted_cash": 476.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2223.0, "discounted_cash": 1667.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4328.0, "discounted_cash": 3246.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1534.0, "discounted_cash": 1150.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW .035", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 75.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW AMPLATZ XSTIFF", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 232.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ANGIO", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 628.0, "discounted_cash": 471.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ASAHI CONFLANZA PRO", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1036.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ASAHI MIRACLEBROS", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246595", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1036.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ASAHI PROWATER", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073099", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4180.0, "discounted_cash": 3135.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ASAHI SION BLACK", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW BLUNT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "4032518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 254.0, "discounted_cash": 190.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW BREAST TUMOR LOCALZ", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW C HI-TORQ WHISPER", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1308.0, "discounted_cash": 981.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW DRILL TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 401.0, "discounted_cash": 300.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW F/TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE GOLD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 910.0, "discounted_cash": 682.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE STD ANGLE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1212.0, "discounted_cash": 909.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE STD STRT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 889.0, "discounted_cash": 666.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE STIFF", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2546.0, "discounted_cash": 1909.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW GLIDEWIRE STIFF ANG", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 437.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HI-TORQ BALANCE MW", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.0, "discounted_cash": 476.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HI-TORQ STEELCORE 18", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241294", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HI-TORQ WIGGLE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.0, "discounted_cash": 476.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HITORQ EX SUPPORT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2869.0, "discounted_cash": 2151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HITORQ STD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 809.0, "discounted_cash": 606.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HITORQ WHOLY FLPPY145", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1036.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HITORQ WHOLY J SYS260", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 351.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW HP JAGWIRE SNGL USE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2989.0, "discounted_cash": 2241.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW J", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1138.0, "discounted_cash": 853.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW J TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 387.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW KT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW NITINOL PLATINUM TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 596.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW NITINOL ULTRASELECT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 310.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PERIPH THRUWAY STR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1056.0, "discounted_cash": 792.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PERIPHERAL ASAHI HALBRED", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 862.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PRESSR AERIS AGILE TP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4703.0, "discounted_cash": 3527.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PRESSURE VERRATA", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4493.0, "discounted_cash": 3369.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PROTRACK PIGTAIL TRANSSEPT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1503.0, "discounted_cash": 1127.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PTCA CHOICE 182/300", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 402.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW PTCA LUGE 182/300", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8241212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 402.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GW SAFARI ALL CURVES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2507.0, "discounted_cash": 1880.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW ST/JC", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 308.25, "setting": "both", "billing_class": "facility"}]}, {"description": "GW STINGRAY", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8073520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2165.0, "discounted_cash": 1623.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GW STR MOVABLE CORE", "code_information": [{"code": "C1769", "type": "HCPCS"}, 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"standard_charge_dollar": 54.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAEMOPH B PRP-OMP .5MLIJ", "code_information": [{"code": "90647", "type": "CPT"}, {"code": "5320971", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 124.3, "maximum": 124.3, "gross_charge": 1874.0, "discounted_cash": 1405.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAEMOPH B PRP-OMP .5MLIJ", "code_information": [{"code": "90647", "type": "CPT"}, {"code": "5320971", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 124.3, "maximum": 124.3, "gross_charge": 1874.0, "discounted_cash": 1405.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR ANALYSIS", "code_information": [{"code": "P2031", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 18.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAIR REMOVAL BY ELECTROLYSIS", "code_information": [{"code": "17380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 286.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL 1-15 PUNCH GRFTS", "code_information": [{"code": "15775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 922.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 456.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL >15 PUNCH GRAFTS", "code_information": [{"code": "15776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1264.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 617.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HALOPERID DEC PER 50MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1631", "type": "HCPCS"}, {"code": "5320973", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 33.29, "maximum": 33.29, "gross_charge": 524.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERID DEC PER 50MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1631", "type": "HCPCS"}, {"code": "5320973", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 33.29, "maximum": 33.29, "gross_charge": 524.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305610", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305610", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305614", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305614", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305618", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305618", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305622", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305622", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL UP TO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1630", "type": "HCPCS"}, {"code": "5320972", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5.37, "maximum": 5.37, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL UP TO 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1630", "type": "HCPCS"}, {"code": "5320972", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.37, "maximum": 5.37, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315358", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL2MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315358", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND 2 VIEWS", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "4903120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.97, "gross_charge": 2630.0, "discounted_cash": 1972.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 82.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 91.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND 3 VIEWS MINIMUM", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "4903130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.2, "gross_charge": 2572.0, "discounted_cash": 1929.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 55.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 99.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 110.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND HELD NEB TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5500122", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.9, "gross_charge": 521.0, "discounted_cash": 390.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17085.88, "maximum": 36105.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21069.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18400.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17775.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17085.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28592.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36105.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "514", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11095.02, "maximum": 23445.43, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13106.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11948.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11542.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11095.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18567.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23445.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17175.39, "maximum": 45049.26, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17175.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22958.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22178.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21318.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35675.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45049.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2537.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 841.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2785.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 923.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3100.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HANTA VIRUS AB", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "7256793", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.85, "gross_charge": 308.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN QUANT", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "7253010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.72, "gross_charge": 199.0, "discounted_cash": 149.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 298.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 453.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 315.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1495.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 497.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1208.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1120.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 373.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVESTING OF DONOR MULTIVIS", "code_information": [{"code": "S2055", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 177.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 177.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.21, "methodology": "fee schedule"}], "billing_class": 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[{"code": "C1776", "type": "HCPCS"}, {"code": "4013052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3097.0, "discounted_cash": 2322.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL UNIPOLR STRYK CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2467.0, "discounted_cash": 1850.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORL ALL METAL STRK CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2467.0, "discounted_cash": 1850.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HIP MOD OSTEOREMEDIES CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35943.0, "discounted_cash": 26957.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUM STD OFFST ECC ZIM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12376.0, "discounted_cash": 9282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUM STD OFST ECC DEPY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15957.0, "discounted_cash": 11967.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HEADACHES WITH MCC", "code_information": [{"code": "102", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12165.13, "maximum": 25706.72, "estimated_discounted_cash": 104546.5, "setting": "inpatient", "payers_information": [{"payer_name": 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[{"code": "V5050", "type": "HCPCS"}], "standard_charges": [{"minimum": 2182.11, "maximum": 2182.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2182.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID REPAIR/MODIFYING", "code_information": [{"code": "V5014", "type": "HCPCS"}], "standard_charges": [{"minimum": 337.84, "maximum": 337.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 611.61, "maximum": 2577.61, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 615.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 683.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2577.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 611.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 611.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 611.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 611.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 611.61, 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING SCREENING", "code_information": [{"code": "V5008", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.85, "maximum": 136.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING SERVICE", "code_information": [{"code": "V5299", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9214.2, "maximum": 19470.97, "estimated_discounted_cash": 52973.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14312.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9923.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9586.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9214.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15419.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19470.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13933.08, "maximum": 29442.67, "estimated_discounted_cash": 80584.16, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21994.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15005.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14495.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13933.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23316.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29442.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6142.8, "maximum": 12980.64, "estimated_discounted_cash": 17982.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9851.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6615.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6390.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6142.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10279.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12980.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 336.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 771.52, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 288.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 977.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1085.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 561.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 181.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 795.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 526.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 219.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 715.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 795.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 436.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1021.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 659.18, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 287.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 919.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1021.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 687.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 308.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 276.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 618.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 687.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 491.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 984.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 555.72, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 314.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 886.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 984.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 592.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 863.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 426.66, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 266.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 777.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 863.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 532.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 174.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 460.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5516.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5516.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1847.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR", "code_information": [{"code": "331T", "type": "CPT"}], "standard_charges": [{"minimum": 632.94, "maximum": 632.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 632.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR SPECT", "code_information": [{"code": "332T", "type": "CPT"}], "standard_charges": [{"minimum": 1090.94, "maximum": 1090.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1090.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TMR W/OTHER PROCEDURE", "code_information": [{"code": "33141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 466.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 156.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "1", "type": "MS-DRG"}], "standard_charges": [{"minimum": 304143.39, "maximum": 642700.12, "estimated_discounted_cash": 1633684.44, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 369936.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 327543.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 316417.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 304143.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 508970.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 642700.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [{"code": "2", "type": "MS-DRG"}], "standard_charges": [{"minimum": 122984.03, "maximum": 259883.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 228471.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 132446.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 127947.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 122984.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 205808.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 259883.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEAT QUANT SENSORY TEST", "code_information": [{"code": "109T", "type": "CPT"}], "standard_charges": [{"minimum": 120.24, "maximum": 120.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAL ANY ANAL", "code_information": [{"code": "83015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAN", "code_information": [{"code": "83018", "type": "CPT"}, {"code": "7252274", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.29, "gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.65, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES DIRECT", "code_information": [{"code": "85441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES INDUCED", "code_information": [{"code": "85445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HELICOBACTER PYLORI AB", "code_information": [{"code": "86677", "type": "CPT"}, {"code": "7256057", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.91, "gross_charge": 269.0, "discounted_cash": 201.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HELICOLL, PER SQUARE CM", "code_information": [{"code": "Q4164", "type": "HCPCS"}], "standard_charges": [{"minimum": 5065.11, "maximum": 5065.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5065.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HELMINTH AB NES", "code_information": [{"code": "86682", "type": "CPT"}, {"code": "7250050", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.35, "gross_charge": 585.0, "discounted_cash": 438.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.26, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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"standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", 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{"code": "7253023", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.82, "gross_charge": 177.0, "discounted_cash": 132.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS", "code_information": [{"code": "86941", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA 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"standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS AUTO", "code_information": [{"code": "86940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 318.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 318.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOPHILIA CLOT FACTOR NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7199", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY BY STAPLING", "code_information": [{"code": "46947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 476.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOSIDERIN QUAL", "code_information": [{"code": "83070", "type": "CPT"}, {"code": "7253070", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.02, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOSTAT SURG VITAGEL", "code_information": [{"code": "A6010", "type": "HCPCS"}, {"code": "8174814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 160.29, "maximum": 160.29, "gross_charge": 2530.0, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B CORE AB IGM", "code_information": [{"code": "86705", "type": "CPT"}, {"code": "4156294", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.64, "gross_charge": 142.0, "discounted_cash": 106.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.59, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEP B VAC 3AG 10MCG 3 DOS IM", "code_information": [{"code": "90759", "type": "CPT"}], "standard_charges": [{"minimum": 279.98, 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"CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB SULFHEMOGLOBIN QUAN", "code_information": [{"code": "83060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHN TX DEMO AND/OR EVAL", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "5500120", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.09, "gross_charge": 896.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA AMP PROBE", "code_information": [{"code": "87532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 219.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 219.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 377.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB PRP-T VACCINE 4 DOSE IM", "code_information": [{"code": "90648", "type": "CPT"}], "standard_charges": [{"minimum": 51.36, "maximum": 51.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 223.6, "maximum": 223.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 223.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 105.75, "maximum": 105.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR CHI", "code_information": [{"code": "L3206", "type": "HCPCS"}], "standard_charges": [{"minimum": 127.14, "maximum": 127.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR INF", "code_information": [{"code": "L3204", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.29, "maximum": 122.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 122.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIGHTOP W/ SUPP/PRONATOR JUN", "code_information": [{"code": "L3207", "type": "HCPCS"}], "standard_charges": [{"minimum": 129.57, "maximum": 129.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22731.61, "maximum": 48035.26, "estimated_discounted_cash": 204610.1, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28811.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24480.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23649.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22731.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38040.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48035.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31607.19, "maximum": 66790.69, "estimated_discounted_cash": 274308.86, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43782.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 34038.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32882.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31607.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52893.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66790.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17701.24, "maximum": 37405.35, "estimated_discounted_cash": 176738.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23664.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19063.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18415.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17701.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29622.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37405.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/DEBRIDEMENT", "code_information": [{"code": "29862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2995.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1001.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2993.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1006.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULOPLASTY", "code_information": [{"code": "29915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3723.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1246.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2624.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 858.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FEMOROPLASTY", "code_information": [{"code": "29914", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3633.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1223.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/LABRAL REPAIR", "code_information": [{"code": "29916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 25686.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3708.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1248.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROSCOPY DX", "code_information": [{"code": "29860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2413.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 815.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP BI W/PEL 2WS", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "4903520", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 454.37, "gross_charge": 1513.0, "discounted_cash": 1134.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 112.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305834", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305836", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305836", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE PAMOATE 25MG", "code_information": [{"code": "Q0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.1, "maximum": 1.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE UPTO25MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3410", "type": "HCPCS"}, {"code": "5321315", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 37.58, "maximum": 37.58, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE UPTO25MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3410", "type": "HCPCS"}, {"code": "5321315", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 37.58, "maximum": 37.58, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDRXINDOL ACD5(HIAA)QT", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "7253497", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.93, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.03, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDRXYPRGSTRONE 17-D", "code_information": [{"code": "83498", "type": "CPT"}, {"code": "7250260", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.06, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.75, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 61.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 58.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYMOVIS INJECTION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7322", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.48, "maximum": 65.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3598.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1200.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305865", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .125MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305865", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .375MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305893", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE .375MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305893", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1980", "type": "HCPCS"}], "standard_charges": [{"minimum": 134.51, "maximum": 134.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 128.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12915.07, "maximum": 27291.46, "estimated_discounted_cash": 64491.06, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14592.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13908.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13436.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12915.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21612.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27291.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8195.1, "maximum": 17317.46, "estimated_discounted_cash": 69939.02, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9137.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8825.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8525.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8195.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13714.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17317.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [{"code": "78", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13638.04, "maximum": 13638.04, "estimated_discounted_cash": 76237.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13638.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [{"code": "77", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23667.34, "maximum": 23667.34, "estimated_discounted_cash": 141443.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23667.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC", "code_information": [{"code": "79", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9727.72, "maximum": 9727.72, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9727.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1722.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 535.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1370.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1522.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1722.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 571.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3304.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 733.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1089.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2974.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3304.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3069.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1017.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2766.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 648.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1581.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2489.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2766.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2236.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 731.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4026.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 942.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1501.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3624.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4026.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3552.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1167.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2015.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 465.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 626.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1550.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1723.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2015.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 662.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTONIC SALINE SOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7131", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 317.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 777.03, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 777.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 258.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 220.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPRPHENYLALNINMIA MNTR QUAN", "code_information": [{"code": "382U", "type": "CPT"}], "standard_charges": [{"minimum": 46.48, "maximum": 46.48, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYQVIA 100MG IMMUNEGLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.8, "maximum": 64.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3935.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1307.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3626.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1208.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3877.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1288.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYSTEROSALPINGOGRAPHY", "code_information": [{"code": "74740", "type": "CPT"}, {"code": "4904740", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 282.91, "gross_charge": 3298.0, "discounted_cash": 2473.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 141.88, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 92.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 254.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 282.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY ABLATION", "code_information": [{"code": "58563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5488.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 892.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1928.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2382.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1928.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY BIOPSY", "code_information": [{"code": "58558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1137.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1506.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1137.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4922.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 550.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 219.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 219.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1031.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 343.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE FB", "code_information": [{"code": "58562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 805.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 220.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 494.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 220.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY REMOVE MYOMA", "code_information": [{"code": "58561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1299.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 432.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1135.36, "methodology": "fee schedule"}, 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"standard_charge_dollar": 298.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Hemodialysis - Outpatient Or Home Composite Or Other Rate", "code_information": [{"code": "821", "type": "RC"}], "standard_charges": [{"minimum": 1044.0, "maximum": 1161.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1044.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1161.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hemodialysis - Outpatient Or Home General", "code_information": [{"code": "820", "type": "RC"}], "standard_charges": [{"minimum": 1044.0, "maximum": 1161.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1044.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1161.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hepatology (nonalcoholic steatohepatitis [NASH]), miR-34a-5p, alpha 2-macroglobulin, YKL40, HbA1c, serum and whole blood, algorithm reported as a single score for NASH activity and fibrosis", "code_information": [{"code": "468U", "type": "CPT"}], "standard_charges": [{"minimum": 226.53, "maximum": 226.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 226.53, 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schedule"}], "billing_class": "facility"}]}, {"description": "Human papillomavirus (HPV), E6/E7 markers for high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68), cervical cells, branched-chain capture hybridization, reported as negative or positive for high risk for HPV", "code_information": [{"code": "502U", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 31.58, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I & D OF VULVA/PERINEUM", "code_information": [{"code": "56405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1784.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 467.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAG HEMATOMA NON-OB", "code_information": [{"code": "57023", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1173.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 389.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAGINAL HEMATOMA PP", "code_information": [{"code": "57022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 221.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I 123 DIAGNOSTIC PER MCI", "code_information": [{"code": "A9509", "type": "HCPCS"}, {"code": "5199509", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 777.19, "maximum": 777.19, "gross_charge": 5600.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 777.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I 123 SOD CAP PER 100UCI", "code_information": [{"code": "A9516", "type": "HCPCS"}, {"code": "5199516", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 406.61, "maximum": 406.61, "gross_charge": 1838.0, "discounted_cash": 1378.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 406.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSC INTRAORAL SOFT TISS", "code_information": [{"code": "D7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 300.1, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 300.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS COMP/MULTIPLE", "code_information": [{"code": "10061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1745.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 676.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS EXTRAORAL", "code_information": [{"code": "D7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 667.91, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS P-SPINE L/S/LS", "code_information": [{"code": "22015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3476.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1168.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMP/SNGL", "code_information": [{"code": "6900051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 883.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMP/SNGL", "code_information": [{"code": "6900051", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1178.0, "discounted_cash": 883.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMPLE/SINGLE", "code_information": [{"code": "10060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 27222.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 391.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 155.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D COMPLEX PO WOUND INFCTJ", "code_information": [{"code": "10180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 652.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 88.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 88.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "4610135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9438.0, "discounted_cash": 7078.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "6909896", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9206.0, "discounted_cash": 6904.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HEMA SEROMA FL", "code_information": [{"code": "6909896", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 9206.0, "discounted_cash": 6904.5, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D HMTMA SEROMA/FLUID COLLJ", "code_information": [{"code": "10140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 16039.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 205.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D P-SPINE C/T/CERV-THOR", "code_information": [{"code": "22010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3558.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1197.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST COMP", "code_information": [{"code": "10081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 624.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 181.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST SIMPLE", "code_information": [{"code": "10080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4152.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 385.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 151.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 297.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 151.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D SKIN ABSCESS COMPLEX", "code_information": [{"code": "6900052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D SKIN ABSCESS COMPLEX", "code_information": [{"code": "6900052", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "I&D UPR A/E BURSA", "code_information": [{"code": "23931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 596.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E DP ABSC/HMTMA", "code_information": [{"code": "23930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 790.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I125 IOTHALAMATE, DX", "code_information": [{"code": "A9554", "type": "HCPCS"}], "standard_charges": [{"minimum": 162.15, "maximum": 162.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I125 SERUM ALBUMIN, DX", "code_information": [{"code": "A9532", "type": "HCPCS"}], "standard_charges": [{"minimum": 1069.63, "maximum": 1069.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1069.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I131 IODOBENGUATE, DX", "code_information": [{"code": "A9508", "type": "HCPCS"}], "standard_charges": [{"minimum": 1527.78, "maximum": 1527.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1527.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I131 SERUM ALBUMIN, DX", "code_information": [{"code": "A9524", "type": "HCPCS"}], "standard_charges": [{"minimum": 2675.73, "maximum": 2675.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2675.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256072", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.86, "gross_charge": 651.0, "discounted_cash": 488.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/2", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256313", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.86, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECT AGENT AB QN NOS/3", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "7256314", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.86, "gross_charge": 150.0, "discounted_cash": 112.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IA INFECTIOUS AGENT ANTIBODY", "code_information": [{"code": "86318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 325.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CHLMYD&GONORR AMP PRB", "code_information": [{"code": "353U", "type": "CPT"}], "standard_charges": [{"minimum": 266.19, "maximum": 266.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA CNS PTHGN NEXT GEN SEQ", "code_information": [{"code": "323U", "type": "CPT"}], "standard_charges": [{"minimum": 1462.89, "maximum": 8064.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1462.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1625.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8064.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GI PTHGN 31 ORG&21 ARG", "code_information": [{"code": "369U", "type": "CPT"}], "standard_charges": [{"minimum": 1580.85, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 20BCT&FNG ORG", "code_information": [{"code": "321U", "type": "CPT"}], "standard_charges": [{"minimum": 436.79, "maximum": 2407.95, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 436.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 485.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2407.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 571.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN 21 ORG&21ARG", "code_information": [{"code": "374U", "type": "CPT"}], "standard_charges": [{"minimum": 1580.85, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA GU PTHGN SEMIQ DNA16&1", "code_information": [{"code": "371U", "type": "CPT"}], "standard_charges": [{"minimum": 283.92, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 283.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 315.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA RSP TR NFCT 17 8 13&16", "code_information": [{"code": "373U", "type": "CPT"}], "standard_charges": [{"minimum": 1580.85, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA SURG WND PTHGN 34&21", "code_information": [{"code": "370U", "type": "CPT"}], "standard_charges": [{"minimum": 1580.85, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IADNA VAG PTHGN PANEL 27 ORG", "code_information": [{"code": "330U", "type": "CPT"}], "standard_charges": [{"minimum": 283.92, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 283.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 315.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBANDRONATE SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1740", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.09, "maximum": 97.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 1684.68, "maximum": 9287.39, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1684.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1871.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9287.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2203.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 100MG/5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 100MG/5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315335", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 200MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5305909", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 200MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5305909", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IBUPROFEN 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305915", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305915", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305919", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 600MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305919", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305920", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN 800MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305920", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1741", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.25, "maximum": 9.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUTILIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}, {"code": "5321314", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 777.8, "maximum": 777.8, "gross_charge": 1978.0, "discounted_cash": 1483.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 777.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUTILIDE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}, {"code": "5321314", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 777.8, "maximum": 777.8, "gross_charge": 1978.0, "discounted_cash": 1483.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 777.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IC INF PBW 2501-5000 G SUBSQ", "code_information": [{"code": "99480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 422.65, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 422.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF 1500-2500 G SUBSQ", "code_information": [{"code": "99479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 439.95, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 439.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IC LBW INF < 1500 GM SUBSQ", "code_information": [{"code": "99478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 483.99, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 483.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ICATIBANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1744", "type": "HCPCS"}], "standard_charges": [{"minimum": 449.89, "maximum": 449.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 449.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICD EVAL IN PERSN NO PRG", "code_information": [{"code": "93289", "type": "CPT"}, {"code": "4613289", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 131.84, "gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 131.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICD PERIPROC EVAL/PRGRM", "code_information": [{"code": "93287", "type": "CPT"}, {"code": "4613287", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 112.46, "gross_charge": 1080.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 515.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 143.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX EACH ADDL NJX", "code_information": [{"code": "709T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 93.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX PREP & 1ST NJX", "code_information": [{"code": "708T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 308.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDARUBICIN PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9211", "type": "HCPCS"}, {"code": "5321321", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 162.83, "maximum": 162.83, "gross_charge": 4374.0, "discounted_cash": 3280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDARUBICIN PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9211", "type": "HCPCS"}, {"code": "5321321", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 162.83, "maximum": 162.83, "gross_charge": 4374.0, "discounted_cash": 3280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDARUCIZUMAB 5GM IJ", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "5321249", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15616.0, "discounted_cash": 11712.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDARUCIZUMAB 5GM IJ", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "5321249", "type": "CDM"}, 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDH1 (isocitrate dehydrogenase 1 [NADP+]), IDH2 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"standard_charge_dollar": 267.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 297.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1121.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFOSFAMIDE PER1GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9208", "type": 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"maximum": 62.43, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.81, 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"standard_charge_dollar": 26.24, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE ANLS AMP METHOD", "code_information": [{"code": "81261", "type": "CPT"}, {"code": "7251262", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 750.98, "gross_charge": 727.0, "discounted_cash": 545.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 385.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH 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"standard_charge_dollar": 178.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 260.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 84.9, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH VARIABLE MUTATION", "code_information": [{"code": "81263", "type": "CPT"}, {"code": "7251264", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1117.11, "gross_charge": 2194.0, "discounted_cash": 1645.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 572.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 664.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 235.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 261.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1117.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH VARIABLE MUTATION", "code_information": [{"code": "81263", "type": "CPT"}, {"code": "7270021", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1117.11, "gross_charge": 2013.0, "discounted_cash": 1509.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 572.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 664.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 235.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 261.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1117.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 265.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 786.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 158.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 786.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IGK GENE REARRANGE ANLS", "code_information": [{"code": "81264", "type": "CPT"}, {"code": "7251265", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 655.16, "gross_charge": 727.0, "discounted_cash": 545.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 290.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 337.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 119.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 132.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 655.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 155.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 225.8, "maximum": 225.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 225.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 278.41, "maximum": 278.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 65.39, "maximum": 65.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 22.83, "maximum": 22.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90658", "type": "CPT"}], "standard_charges": [{"minimum": 69.18, "maximum": 69.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 82.08, "maximum": 82.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 39.6, "maximum": 39.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 79.2, "maximum": 79.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IKBKAP COMMON VARIANTS", "code_information": [{"code": "81260", "type": "CPT"}, {"code": "7251261", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 28.07, "maximum": 149.1, "gross_charge": 4960.0, "discounted_cash": 3720.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3763.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1260.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC ART BI W CARD CTH", "code_information": [{"code": "G0278", "type": "HCPCS"}, {"code": "4610278", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 13996.0, "discounted_cash": 10497.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9570.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9570.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3211.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 63599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1407.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2162.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2853.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2162.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 650.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 446.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 446.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 38482.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1733.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2652.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3492.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2652.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 27714.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 744.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1085.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1441.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1085.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILOPROST 10MCG/ML 1ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILOPROST 10MCG/ML 1ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331215", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1183.0, "discounted_cash": 887.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILOPROST NON-COMP UNIT DOSE", "code_information": [{"code": "Q4074", "type": "HCPCS"}], "standard_charges": [{"minimum": 556.3, "maximum": 556.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 556.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 226.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1010.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 596.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 10445.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 693.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 712.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1029.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 712.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 693.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 712.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 712.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 733.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 567.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 881.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 567.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMATINIB 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305930", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 277.0, "discounted_cash": 207.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMATINIB 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305930", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 277.0, "discounted_cash": 207.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMATINIB 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305931", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMATINIB 400MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305931", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG CATH FLUID COL VISC", "code_information": [{"code": "5059405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID COL VISC", "code_information": [{"code": "5069405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "4919406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "5059406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID PERI/RETR", "code_information": [{"code": "5069406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG CATH FLUID TRNS/VAG", "code_information": [{"code": "5059407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16037.0, "discounted_cash": 12027.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMG GID FLU COLL DRG SFT TIS", "code_information": [{"code": "10030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 484.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 523.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 523.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 16.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 170.21, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 153.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 170.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPENEM/CIL PER250MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "5321324", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 30.73, "maximum": 30.73, "gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPENEM/CIL PER250MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "5321324", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 30.73, "maximum": 30.73, "gross_charge": 41.0, "discounted_cash": 30.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305949", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPRAMINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305949", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPRAMINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6103998", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.6, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6160472", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.6, "gross_charge": 112.0, "discounted_cash": 84.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADM EA ADDL VACCINE", "code_information": [{"code": "90472", "type": "CPT"}, {"code": "6290472", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.6, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADMIN SNGL/COMBO VAC", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "4540471", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.44, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADMIN SNGL/COMBO VAC", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6103996", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.44, "gross_charge": 288.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMM ADMIN SNGL/COMBO VAC", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "6290471", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 75.44, "gross_charge": 265.0, "discounted_cash": 198.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMCYT MLTIPLEX AB STAIN", "code_information": [{"code": "88344", "type": "CPT"}, {"code": "4308344", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 493.89, "gross_charge": 835.0, "discounted_cash": 626.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 256.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": 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"standard_charge_dollar": 1113.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV COMP BONY", "code_information": [{"code": "D7240", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.26, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 802.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV PART BONY", "code_information": [{"code": "D7230", "type": "HCPCS"}], "standard_charges": [{"minimum": 667.91, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV SOFT TISS", "code_information": [{"code": "D7220", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.04, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 513.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPELLA RP FLEX W/SMARTASSIST", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8143277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 250000.0, "discounted_cash": 187500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1388.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 473.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPL ANCHOR CRKSCRW 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8151980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3975.0, "discounted_cash": 2981.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2270.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 756.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69729", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2461.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 819.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SKULL PERQ ESP", "code_information": [{"code": "69714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1813.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 604.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL ORBITAL", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8152014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 7124.0, "discounted_cash": 5343.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL ORBITAL FLOOR", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8152010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 11749.0, "discounted_cash": 8811.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL RETINAL", "code_information": [{"code": "L8610", "type": "HCPCS"}, {"code": "8152029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2602.23, "maximum": 2602.23, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2602.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SLEEVE TYPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8152032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1713.0, "discounted_cash": 1284.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL SUTURE ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8152038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9820.0, "discounted_cash": 7365.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2582.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT AUDITORY BRAIN IMP", "code_information": [{"code": "S2235", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BLOCKER XIA", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8136448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4495.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4495.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1508.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5577.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5577.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1868.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5755.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5755.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1938.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT COCHLEAR DEVICE", "code_information": [{"code": "69930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4443.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1473.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT CONNECTING BAR", "code_information": [{"code": "D6055", "type": "HCPCS"}], "standard_charges": [{"minimum": 3150.96, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3150.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3065.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1019.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT HORMONE PELLET(S)", "code_information": [{"code": "11980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 200.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 114.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT MAINTENANCE", "code_information": [{"code": "D6080", "type": "HCPCS"}], "standard_charges": [{"minimum": 295.17, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT MANDIBLE FOR AUGMENT", "code_information": [{"code": "D7996", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT NERVE END", "code_information": [{"code": "64787", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 842.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1014.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 339.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1791.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 598.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5506.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1844.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8298.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8298.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2777.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3616.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1211.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5703.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5703.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1909.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1513.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1948.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2656.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1948.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "63655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3076.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1033.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4501.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1644.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3567.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4501.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3567.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1180.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1882.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2482.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1882.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20994.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1102.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 451.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 865.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 451.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3242.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1087.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT PROCEDURE", "code_information": [{"code": "D6199", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SEMI-IMP HEAR", "code_information": [{"code": "S2230", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPACER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 59869.0, "discounted_cash": 44901.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1458.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 489.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3345.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1122.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1602.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 537.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1411.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 472.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED CROWN", "code_information": [{"code": "D6065", "type": "HCPCS"}], "standard_charges": [{"minimum": 2099.46, "maximum": 2099.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6066", "type": "HCPCS"}], "standard_charges": [{"minimum": 2099.46, "maximum": 2099.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6067", "type": "HCPCS"}], "standard_charges": [{"minimum": 2099.46, "maximum": 2099.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6075", "type": "HCPCS"}], "standard_charges": [{"minimum": 1696.57, "maximum": 1696.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1696.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6076", "type": "HCPCS"}], "standard_charges": [{"minimum": 1645.71, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1645.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6077", "type": "HCPCS"}], "standard_charges": [{"minimum": 1830.77, "maximum": 1830.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1830.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4658.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1545.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3352.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1124.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4608.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4608.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1542.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5567.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5567.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1860.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEARING AID", "code_information": [{"code": "69710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11870.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 313.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPLT NEUROSTIM ELCTR EACH", "code_information": [{"code": "L8680", "type": "HCPCS"}], "standard_charges": [{"minimum": 839.16, "maximum": 839.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 839.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN DUA REC", "code_information": [{"code": "L8687", "type": "HCPCS"}], "standard_charges": [{"minimum": 31087.2, "maximum": 31087.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31087.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN SNG NON", "code_information": [{"code": "L8686", "type": "HCPCS"}], "standard_charges": [{"minimum": 15242.06, "maximum": 15242.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15242.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT NROSTM PLS GEN SNG REC", "code_information": [{"code": "L8685", "type": "HCPCS"}], "standard_charges": [{"minimum": 23886.95, "maximum": 23886.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23886.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 605.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 605.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 615.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 615.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3216.54, "estimated_discounted_cash": 62168.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3216.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1610.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1755.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2456.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1755.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1069.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9003.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9003.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3003.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMPORTED LIPODOX INJ", "code_information": [{"code": "Q2049", "type": "HCPCS"}], "standard_charges": [{"minimum": 1928.36, "maximum": 1928.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1928.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPRESSION CASTING FT", "code_information": [{"code": "S0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": 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"standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN SITU EA PRB PER SPEC", 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 79.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN-PERSON ATTENDANCE G CODE", "code_information": [{"code": "G9886", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.83, "maximum": 94.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 CAPROMAB", "code_information": [{"code": "A9507", "type": "HCPCS"}], "standard_charges": [{"minimum": 3168.07, "maximum": 3168.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3168.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 DTPA .5MCI", "code_information": [{"code": "A9548", "type": "HCPCS"}, {"code": "5191724", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 3646.59, "maximum": 3646.59, "gross_charge": 3478.0, "discounted_cash": 2608.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3646.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 IBRITUMOMAB, DX", "code_information": [{"code": "A9542", "type": "HCPCS"}], "standard_charges": [{"minimum": 15134.07, "maximum": 15134.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15134.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 OXYQUINOLINE", "code_information": [{"code": "A9547", "type": "HCPCS"}], "standard_charges": [{"minimum": 8350.44, "maximum": 8350.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8350.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 SATUMOMAB", "code_information": [{"code": "A4642", "type": "HCPCS"}], "standard_charges": [{"minimum": 6429.74, "maximum": 6429.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6429.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 985.61, "maximum": 985.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 985.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15434.05, "maximum": 32614.44, "estimated_discounted_cash": 56959.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16650.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16621.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16056.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15434.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25828.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32614.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC DP OPN B1 CRTX HUM/ELBW", "code_information": [{"code": "23935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1906.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC&RMVL FB SUBQ TISS COMP", "code_information": [{"code": "10121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 670.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC&RMVL FB SUBQ TISS SMPL", "code_information": [{"code": "10120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9681.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 387.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2581.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 204.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 185.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6528.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2185.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG LUMBAR", "code_information": [{"code": "22214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5531.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1857.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5531.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1859.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS ADDL SPINE SEGMENT", "code_information": [{"code": "22216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1301.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 437.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2116.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 710.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8723.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8723.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2915.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN THORAC", "code_information": [{"code": "22206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8906.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8906.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2988.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADDER", "code_information": [{"code": "51040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 21166.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1071.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1724.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 1736.63, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1736.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4599.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4599.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1539.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1818.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 601.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1567.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE EXTERNAL HEMORRHOID", "code_information": [{"code": "46083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15447.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE FINGER TENDON SHEATH", "code_information": [{"code": "26055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 18224.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1088.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 307.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 710.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 307.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE FLEXOR CARPI RADIALIS", "code_information": [{"code": "25001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1300.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 440.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HAND/FINGER TENDON", "code_information": [{"code": "26460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1670.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 554.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1883.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 632.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2322.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 778.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 453.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5490.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1823.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6370.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2121.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 900.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 370.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1736.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 575.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2156.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 717.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2302.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 763.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2418.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 802.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2025.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1867.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 626.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7980.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2668.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7326.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2460.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7259.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2430.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6992.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2340.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7671.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2567.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5914.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1980.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5686.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1886.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5140.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5140.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1724.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4653.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4653.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1558.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5830.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5830.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1952.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6236.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6236.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2088.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6167.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2065.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1546.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1919.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 642.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5827.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1952.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4524.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1519.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV HALF SEGMNT", "code_information": [{"code": "63185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4507.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1511.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 365.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2688.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE THIGH TENDON & FASCIA", "code_information": [{"code": "27305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1790.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 602.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE WRIST/FOREARM TENDON", "code_information": [{"code": "25290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1624.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 547.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 400.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 147.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 603.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 392.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/GRAFT MIDFOOT BONES", "code_information": [{"code": "28305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2481.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 830.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 673.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 396.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 18262.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 989.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 334.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL ABSCESS", "code_information": [{"code": "46050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4031.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 372.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 993.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SPHINCTER", "code_information": [{"code": "46080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANKLE BONE", "code_information": [{"code": "28302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2637.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4850.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4850.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1618.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4950.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4950.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1656.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7829.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2621.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9285.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9285.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3107.52, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 708.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 236.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1895.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 637.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1216.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 414.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1866.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 444.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 230.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 557.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 185.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2065.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4685.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1567.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3054.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1014.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "66172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4332.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1439.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 356.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 283.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID FOLD", "code_information": [{"code": "67715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 311.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1809.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 605.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FIBULA", "code_information": [{"code": "27707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1503.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 505.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 954.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1705.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 566.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT FASCIA", "code_information": [{"code": "28008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1087.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 519.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON", "code_information": [{"code": "28234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 998.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 497.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT TENDON(S)", "code_information": [{"code": "28230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1052.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3185.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1071.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1193.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 400.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2945.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 991.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2755.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 923.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEEL BONE", "code_information": [{"code": "28300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2392.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 804.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4668.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1568.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5753.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1932.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1446.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 483.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1994.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 668.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2217.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 744.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2650.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 893.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDONS", "code_information": [{"code": "27006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2634.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 884.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP/THIGH FASCIA", "code_information": [{"code": "27025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3405.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1154.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1435.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1560.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 513.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2706.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 909.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1644.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 552.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF KNEE JOINT", "code_information": [{"code": "27435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2972.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 998.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3557.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1194.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIP FOLD", "code_information": [{"code": "40806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 107.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7760.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2595.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1716.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1503.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 209.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 209.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 24998.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1912.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 274.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 953.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 274.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 14498.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1433.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 188.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 692.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 188.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSALS", "code_information": [{"code": "28309", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3321.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1114.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF MIDFOOT BONES", "code_information": [{"code": "28304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2258.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 221.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4456.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1496.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1716.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 570.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1739.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 583.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2514.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 869.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1561.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 680.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1611.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 540.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1784.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 600.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3088.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1028.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1018.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 464.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPINAL NERVE", "code_information": [{"code": "64772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 24806.11, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2051.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 687.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3344.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1120.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON & MUSCLE", "code_information": [{"code": "23405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2268.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 760.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON SHEATH", "code_information": [{"code": "25000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 18515.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1294.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 435.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3041.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1022.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3696.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1237.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1276.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1675.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1514.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 512.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2143.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 721.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2632.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 884.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA", "code_information": [{"code": "27705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2752.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 917.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA & FIBULA", "code_information": [{"code": "27709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4185.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1399.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 10708.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 770.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 289.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 892.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 454.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "28011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1033.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 391.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE FOLD", "code_information": [{"code": "41010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 111.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 256.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 111.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1678.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1093.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1903.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 638.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1630.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 544.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1153.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 384.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1186.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 398.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3498.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1160.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WRIST CAPSULE", "code_information": [{"code": "25085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1670.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION SECONDARY CATARACT", "code_information": [{"code": "66820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1704.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 557.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS EXTRA", "code_information": [{"code": "D7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 834.88, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 834.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS INTRA", "code_information": [{"code": "D7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 488.84, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 488.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5004.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1677.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SEP/ADDL", "code_information": [{"code": "6901107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3909.0, "discounted_cash": 2931.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SEP/ADDL", "code_information": [{"code": "6901107", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3909.0, "discounted_cash": 2931.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SGL LES", "code_information": [{"code": "6901108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5077.0, "discounted_cash": 3807.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INCISIONAL BX SKIN SGL LES", "code_information": [{"code": "6901108", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 5077.0, "discounted_cash": 3807.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}, {"code": "5321293", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 19.67, "maximum": 19.67, "gross_charge": 22.0, "discounted_cash": 16.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}, {"code": "5321293", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 19.67, "maximum": 19.67, "gross_charge": 22.0, "discounted_cash": 16.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOMPL DONOR EGG CASE RATE", "code_information": [{"code": "S4023", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOMPLETE ENDODONTIC TX", "code_information": [{"code": "D3332", "type": "HCPCS"}], "standard_charges": [{"minimum": 544.6, "maximum": 544.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCONTINENCE GARMENT ANYTYPE", "code_information": [{"code": "A4520", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INCONTINENCE SUPPLY", "code_information": [{"code": "A4335", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IND 111 PENTTREOTDE DOSE", "code_information": [{"code": "A9572", "type": "HCPCS"}, {"code": "5199572", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 24543.14, "maximum": 24543.14, "gross_charge": 35509.0, "discounted_cash": 26631.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24543.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDAPAMIDE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305977", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDAPAMIDE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5305977", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDEXING FOR OSTEOTOMY", "code_information": [{"code": "D7939", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDIGOTINDISULFONATE PER1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9220", "type": "HCPCS"}, {"code": "5321230", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INDIGOTINDISULFONATE PER1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9220", "type": "HCPCS"}, {"code": "5321230", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INDIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 141.67, "maximum": 141.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 AUTO PLATELET", "code_information": [{"code": "A9571", "type": "HCPCS"}], "standard_charges": [{"minimum": 16700.88, "maximum": 16700.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16700.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDIUM111 WBC DOSE", "code_information": [{"code": "A9570", "type": "HCPCS"}, {"code": "5199570", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 16700.88, "maximum": 16700.88, "gross_charge": 51299.0, "discounted_cash": 38474.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16700.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDOCYANINE GRN 25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321337", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1250.0, "discounted_cash": 937.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDOMETHACIN 100MG SUPP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338498", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1540.0, "discounted_cash": 1155.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDOMETHACIN 100MG SUPP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": 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"standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DIR OPT", "code_information": [{"code": "87804", "type": "CPT"}, {"code": "4127804", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.77, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DIR OPT", "code_information": [{"code": "87804", "type": "CPT"}, {"code": "4157804", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.77, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DIR OPT", "code_information": [{"code": "87804", "type": "CPT"}, {"code": "4177804", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.77, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DIR OPT/2", "code_information": [{"code": "87804", "type": "CPT"}, {"code": "4107805", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.77, "gross_charge": 554.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 79.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 115.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 52.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 58.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": "87503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 40.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "3220008", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "6100008", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "6160008", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VACC ADMIN", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "6290008", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS AB", "code_information": [{"code": "86710", "type": "CPT"}, {"code": "7256206", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.4, "gross_charge": 179.0, "discounted_cash": 134.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACCINE, NOS", "code_information": [{"code": "Q2039", "type": "HCPCS"}], "standard_charges": [{"minimum": 86.44, "maximum": 86.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 86.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10995.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10995.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3653.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11174.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11174.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3736.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 481.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 177.37, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 185.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 424.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 472.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION THER OTHER THAN CHE", "code_information": [{"code": "Q0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.29, "maximum": 94.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 313.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 313.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 451.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 152.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16545.4, "maximum": 34962.88, "estimated_discounted_cash": 157063.33, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20431.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17818.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17213.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16545.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27687.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34962.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27044.59, "maximum": 57149.23, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35934.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 29125.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28136.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 27044.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 45257.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 57149.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12674.13, "maximum": 26782.33, "estimated_discounted_cash": 260927.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13531.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13649.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13185.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12674.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21209.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26782.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INHALATION SOLUTION FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7699", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}, {"code": "7256354", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.13, "gross_charge": 305.0, "discounted_cash": 228.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 30.26, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHOUSE TRAUMA I-FL TM", "code_information": [{"code": "6109015", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 32363.0, "discounted_cash": 24272.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INHOUSE TRAUMA I-PT TM", "code_information": [{"code": "6109016", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 24271.0, "discounted_cash": 18203.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INHOUSE TRAUMA I-SM TM", "code_information": [{"code": "6109017", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 16182.0, "discounted_cash": 12136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INIT DAY HOSP NEONATE CARE", "code_information": [{"code": "99477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1229.24, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1229.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 408.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY HOSP", "code_information": [{"code": "99460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 337.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT NB EM PER DAY NON-FAC", "code_information": [{"code": "99461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 221.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 221.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 1-4 YRS", "code_information": [{"code": "99382", "type": "CPT"}], "standard_charges": [{"minimum": 31.31, "maximum": 284.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 284.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT 65+ YRS", "code_information": [{"code": "99387", "type": "CPT"}], "standard_charges": [{"minimum": 34.82, "maximum": 443.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 443.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT PM E/M NEW PAT INFANT", "code_information": [{"code": "99381", "type": "CPT"}], "standard_charges": [{"minimum": 31.31, "maximum": 266.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 139.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 139.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL FOOT EXAM PT LOPS", "code_information": [{"code": "G0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 145.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL PREVENTIVE EXAM", "code_information": [{"code": "G0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 477.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 477.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAL TREATMENT OF BURN(S)", "code_information": [{"code": "16000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 220.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ABSC/CYST PREV CATH", "code_information": [{"code": "4919424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2967.0, "discounted_cash": 2225.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ACETAMINOPHEN -FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0134", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.18, "maximum": 0.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "3600775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "4540775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "5606375", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6100775", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6160775", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ADD SEQUENTL IVP", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "6290775", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.87, "gross_charge": 706.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ AIR/CM PERITNL CAV", "code_information": [{"code": "4917690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2605.0, "discounted_cash": 1953.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ AIR/CM PERITNL CAV", "code_information": [{"code": "5059400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2605.0, "discounted_cash": 1953.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ALYMSYS 10 MG", "code_information": [{"code": "Q5126", "type": "HCPCS"}], "standard_charges": [{"minimum": 229.8, "maximum": 229.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANDEXXA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7169", "type": "HCPCS"}], "standard_charges": [{"minimum": 483.61, "maximum": 483.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 483.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANESTH LUMB/CAUD SGL", "code_information": [{"code": "4912315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5050.0, "discounted_cash": 3787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANESTH LUMB/CAUD SGL", "code_information": [{"code": "5057608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5050.0, "discounted_cash": 3787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ANIFROLUMAB-FNIA 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.16, "maximum": 65.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ APOTEX/BENDAMUSTINE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.81, "maximum": 78.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ARIPIPRAZOLE EXT REL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0401", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.83, "maximum": 25.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ AVAL ALFA-NQPT 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 288.33, "maximum": 288.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BELANTAMAB MAFODOT BLMF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9037", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.74, "maximum": 171.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 171.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BENDAMUSTINE, BAXTER 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9059", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.81, "maximum": 78.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON IM 1 MCG", "code_information": [{"code": "Q3027", "type": "HCPCS"}], "standard_charges": [{"minimum": 203.65, "maximum": 203.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 203.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON SQ 1 MCG", "code_information": [{"code": "Q3028", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.71, "maximum": 124.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"minimum": 782.14, "maximum": 782.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 782.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIPERIDEN LACTATE/5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 1.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BLADDER RETRO UR", "code_information": [{"code": "4907620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1129.0, "discounted_cash": 846.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, BAXTER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0689", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.66, "maximum": 4.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, HIKMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0688", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.95, "maximum": 3.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CHEMO ADD DRUG IVP", "code_information": [{"code": "96411", "type": "CPT"}, {"code": "4546411", "type": "CDM"}, {"code": "331", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 197.54, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 63.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CLADRIBINE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.83, "maximum": 59.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CM EVAL DTUBE", "code_information": [{"code": "4919466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4799.0, "discounted_cash": 3599.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CM EVAL GJTUBE", "code_information": [{"code": "4909468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4799.0, "discounted_cash": 3599.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ CODEINE PHOSPHATE /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0745", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.12, "maximum": 5.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 482.1, "maximum": 482.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 482.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.68, "maximum": 52.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.39, "maximum": 60.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOS DR.REDDY'S 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.1, "maximum": 12.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.79, "maximum": 6.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 879.08, "maximum": 879.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 879.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DEOXYCHOLIC ACID, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0591", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.03, "maximum": 58.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DEXAMETHASONE ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1094", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.87, "maximum": 0.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DICLOFENAC SODIUM 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1130", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.83, "maximum": 0.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGART-ALFA 2MG HYA-QVFC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9334", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.89, "maximum": 103.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 121.68, "maximum": 121.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFLAPEGRASTIM-XNST 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1449", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.57, "maximum": 112.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ENFORT VEDO-EJFV 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9177", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.86, "maximum": 132.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPCORITAMAB-BYSP 0.16 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9321", "type": "HCPCS"}], "standard_charges": [{"minimum": 204.05, "maximum": 204.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 204.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPID BLD PATCH", "code_information": [{"code": "4912273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3952.0, "discounted_cash": 2964.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID CERV/THORC", "code_information": [{"code": "4912298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4285.0, "discounted_cash": 3213.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID LUMB/CAUD", "code_information": [{"code": "4910404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6672.0, "discounted_cash": 5004.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ EPID LUMB/CAUD", "code_information": [{"code": "5052289", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6672.0, "discounted_cash": 5004.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ ESMOLOL HCL WG CRIT CARE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1806", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.72, "maximum": 1.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ F/CYSTO OR VCUG", "code_information": [{"code": "4907615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1384.0, "discounted_cash": 1038.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ F/CYSTO OR VCUG", "code_information": [{"code": "4917615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1384.0, "discounted_cash": 1038.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ F/CYSTO OR VCUG", "code_information": [{"code": "5051600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1384.0, "discounted_cash": 1038.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"minimum": 235.36, "maximum": 235.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 235.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"minimum": 500.01, "maximum": 500.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 500.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC PYROPHOSPHATE CIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1443", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.08, "maximum": 0.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN ALFA 75 IU", "code_information": [{"code": "S0126", "type": "HCPCS"}], "standard_charges": [{"minimum": 216.77, "maximum": 216.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN BETA 75 IU", "code_information": [{"code": "S0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.85, "maximum": 205.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOR SACROILIAC JT ANESTH", "code_information": [{"code": "G0260", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"minimum": 2633.02, "maximum": 2633.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2633.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GANIRELIX ACETAT 250 MCG", "code_information": [{"code": "S0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 285.76, "maximum": 285.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 285.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.28, "maximum": 33.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 425.12, "maximum": 425.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLOFITAMAB GXBM, 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 10271.17, "maximum": 10271.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10271.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 469.69, "maximum": 469.69, "estimated_discounted_cash": 865.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 469.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.37, "maximum": 17.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.88, "maximum": 152.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HIP ARTHRO W/O ANES", "code_information": [{"code": "4907650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 983.0, "discounted_cash": 737.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ HUMAN FIBRINOGEN CON NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7178", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.24, "maximum": 5.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.03, "maximum": 53.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IMIP 4 CILAS 4 RELEB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0742", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.34, "maximum": 9.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ INOTUZUMAB OZOGAM 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9229", "type": "HCPCS"}], "standard_charges": [{"minimum": 9786.49, "maximum": 9786.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9786.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IRINOTECAN LIPOSOME 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9205", "type": "HCPCS"}], "standard_charges": [{"minimum": 235.24, "maximum": 235.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 235.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LABETALOL HCL HIKMA, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1921", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.69, "maximum": 9.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.75, "maximum": 2.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEVOLEUCOVORIN NOS 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LON TESIRIN-LPYL 0.075MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 760.98, "maximum": 760.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 760.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LUMB/CAUD EA ADD LVL", "code_information": [{"code": "4912316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3729.0, "discounted_cash": 2796.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ LUMB/CAUD EA ADD LVL", "code_information": [{"code": "5057609", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3729.0, "discounted_cash": 2796.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ LUSPATERCEPT-AAMT 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}], "standard_charges": [{"minimum": 151.61, "maximum": 151.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LUXTURNA 1 BILLION VEC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3398", "type": "HCPCS"}], "standard_charges": [{"minimum": 11015.48, "maximum": 11015.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11015.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LYMPHANGIOGRAPHY", "code_information": [{"code": "5208791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 1228.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ MELPHA HYDROCH NOS 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9245", "type": "HCPCS"}], "standard_charges": [{"minimum": 561.44, "maximum": 561.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 561.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MENOTROPINS 75 IU", "code_information": [{"code": "S0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.11, "maximum": 190.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ METARAMINOL BITARTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.42, "maximum": 5.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM (WG CRIT CARE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.08, "maximum": 1.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"minimum": 888.19, "maximum": 888.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 888.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.02, "maximum": 22.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MULTIHANCE MULTIPACK", "code_information": [{"code": "A9578", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.72, "maximum": 6.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.18, "maximum": 97.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MYELOGRAM LUMBAR", "code_information": [{"code": "4907685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NALOXONE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2310", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.64, "maximum": 27.64, "estimated_discounted_cash": 143.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ NEPHROGRM EXIS ACC", "code_information": [{"code": "4917665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3976.0, "discounted_cash": 2982.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NEPHROSTOGRAM", "code_information": [{"code": "4910430", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4368.0, "discounted_cash": 3276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 709.87, "maximum": 709.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 709.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OCTAFLUOROPROPANE MIC,ML", "code_information": [{"code": "Q9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 159.91, "maximum": 159.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.52, "maximum": 168.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"minimum": 1429.83, "maximum": 1429.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1429.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.68, "maximum": 147.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 147.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 1 LEV", "code_information": [{"code": "64490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 2 LEV", "code_information": [{"code": "64491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 214.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT C/T 3 LEV", "code_information": [{"code": "64492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 218.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 1 LEV", "code_information": [{"code": "64493", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 329.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 215.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 2 LEV", "code_information": [{"code": "64494", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 184.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT F JNT L/S 3 LEV", "code_information": [{"code": "64495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 188.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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SUBST", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "6160776", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 35.24, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ T/P/D IVP SAME SUBST", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "6290776", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 35.24, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.56, "maximum": 252.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.76, "maximum": 6.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TENDON ORIGIN/INSERTION", "code_information": [{"code": "20551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TENDON SHEATH/LIGAMENT", "code_information": [{"code": "20550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"minimum": 137.52, "maximum": 137.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 137.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TESTOSTERO ENANTHATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3121", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 70.5, "maximum": 70.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ THEOPHYLLINE PER 40 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2810", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.59, "maximum": 1.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 638.4, "maximum": 638.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 638.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 572.13, "maximum": 572.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 305.2, "maximum": 305.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.53, "maximum": 66.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER POINT 1/2 MUSCL", "code_information": [{"code": "20552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2231.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIMETREXATE GLUCORONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3305", "type": "HCPCS"}], "standard_charges": [{"minimum": 567.85, "maximum": 567.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 567.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "3603072", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "4540330", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "5070782", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "5606372", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6102120", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6160772", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PROPH/DX SQ/IM", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "6290782", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "gross_charge": 484.0, "discounted_cash": 363.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "3600774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "4540774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "5076374", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "5606374", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6100774", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6160774", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TX/PRPH/DX IVP INT", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "6290774", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.48, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"minimum": 256.65, "maximum": 256.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 256.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ URETER/ILEAL CONDUIT", "code_information": [{"code": "4907735", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3188.0, "discounted_cash": 2391.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ URETERAL CATHETER", "code_information": [{"code": "4910684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1916.0, "discounted_cash": 1437.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ VASOPRESSIN (AM REG) 1 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.76, "maximum": 1.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VELMANASE ALFA-TYCV 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0217", "type": "HCPCS"}], "standard_charges": [{"minimum": 1327.55, "maximum": 1327.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1327.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VENOGRPHY EXTRMTY", "code_information": [{"code": "4617690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 684.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ VENOGRPHY EXTRMTY", "code_information": [{"code": "4916005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 913.0, "discounted_cash": 684.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 21777.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ WRIST ARTHROGRAM", "code_information": [{"code": "4907745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 760.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"minimum": 184.28, "maximum": 184.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 184.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ&CATH HYSTER/SONOHYST", "code_information": [{"code": "4907740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1198.0, "discounted_cash": 898.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ&CATH HYSTER/SONOHYST", "code_information": [{"code": "5067740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.0, "discounted_cash": 834.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJ, ABILIFY ASIMTUFII, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.32, "maximum": 22.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADO-TRASTUZUMAB EMT 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.53, "maximum": 145.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADUCANUMAB-AVWA, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0172", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.67, "maximum": 22.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AFSTYLA, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.47, "maximum": 5.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMIODARONE (NEXTERONE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.74, "maximum": 12.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.89, "maximum": 29.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.77, "maximum": 75.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ASPARA, RYLAZE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 193.28, "maximum": 193.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.89, "maximum": 126.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 151.18, "maximum": 151.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BIORPHEN, 20 MICROGRAMS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2372", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.67, "maximum": 0.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB (MAIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9051", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.38, "maximum": 11.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB FRESENIUSKAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.15, "maximum": 10.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, DR. REDDY'S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 184.14, "maximum": 184.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 184.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, HOSPIRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9049", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.77, "maximum": 5.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BROLUCIZUMAB-DBLL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 1233.64, "maximum": 1233.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1233.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CABOTE RILPIVIR 2MG 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0741", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.71, "maximum": 85.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CARMUSTINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.79, "maximum": 69.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CEFEPIME HCL (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.98, "maximum": 19.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CIMERLI, 0.1 MG", "code_information": [{"code": "Q5128", "type": "HCPCS"}], "standard_charges": [{"minimum": 994.07, "maximum": 994.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 994.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0737", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.64, "maximum": 6.64, "estimated_discounted_cash": 92.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0874", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0877", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9272", "type": "HCPCS"}], "standard_charges": [{"minimum": 884.75, "maximum": 884.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 884.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DUROLANE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7318", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.3, "maximum": 23.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 249.24, "maximum": 249.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EPINEPHRINE (BELCHER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.79, "maximum": 6.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EPIRUBICIN HCL, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9178", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.23, "maximum": 5.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ETELCALCETIDE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0606", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.65, "maximum": 13.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ETEPLIRSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1428", "type": "HCPCS"}], "standard_charges": [{"minimum": 619.02, "maximum": 619.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 619.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 679.48, "maximum": 679.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 679.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FACTOR X, (HUMAN), 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7175", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.56, "maximum": 34.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2777", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.9, "maximum": 136.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FOSAPREPITANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1456", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9394", "type": "HCPCS"}], "standard_charges": [{"minimum": 201.03, "maximum": 201.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9393", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.41, "maximum": 80.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FUROSCIX, 20 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1941", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.05, "maximum": 795.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 795.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FYLNETRA, 0.5 MG", "code_information": [{"code": "Q5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 766.09, "maximum": 766.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 766.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, GADOPICLENOL, 1 ML", "code_information": [{"code": "A9573", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.75, "maximum": 47.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, GANCICLOVIR (EXELA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1574", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.94, "maximum": 165.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, GRANISETRON, XR, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1627", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.52, "maximum": 21.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, HYDROXOCOBALAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3425", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, IDACIO, 20 MG", "code_information": [{"code": "Q5131", "type": "HCPCS"}], "standard_charges": [{"minimum": 12721.76, "maximum": 12721.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12721.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, IMM GLOB BIVIGAM, 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1556", "type": "HCPCS"}], "standard_charges": [{"minimum": 276.74, "maximum": 276.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 276.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA HAFYERA/TRINZA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2427", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.31, "maximum": 46.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, IXINITY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7213", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.88, "maximum": 6.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, KOVALTRY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7211", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.41, "maximum": 5.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LANREOTIDE, (CIPLA) 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1932", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.01, "maximum": 185.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LECANEMAB-IRMB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.11, "maximum": 5.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LENACAPAVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1961", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.19, "maximum": 83.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LINEZOLID (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2021", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.09, "maximum": 76.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MELPHALAN FLUFENAMI 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 1909.78, "maximum": 1909.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1909.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MEROPENEM (B. BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2184", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.01, "maximum": 8.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MICAFUNGIN (PAR PHARM)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2247", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.28, "maximum": 1.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MORPHINE (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.2, "maximum": 28.2, "estimated_discounted_cash": 236.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MOXIFLOXACIN 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2280", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.75, "maximum": 35.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NALOXONE HCL (ZIMHI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2311", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.84, "maximum": 21.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NUSINERSEN, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2326", "type": "HCPCS"}], "standard_charges": [{"minimum": 4295.65, "maximum": 4295.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4295.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NYVEPRIA", "code_information": [{"code": "Q5122", "type": "HCPCS"}], "standard_charges": [{"minimum": 236.6, "maximum": 236.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OCRIPLASMIN, 0.125 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7316", "type": "HCPCS"}], "standard_charges": [{"minimum": 3970.99, "maximum": 3970.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3970.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OLARATUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9285", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.49, "maximum": 197.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OMACETAXINE MEP, 0.01MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9262", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.02, "maximum": 15.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PANZYGA, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1576", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.01, "maximum": 252.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PASIREOTIDE LONG ACTING", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2502", "type": "HCPCS"}], "standard_charges": [{"minimum": 2066.5, "maximum": 2066.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2066.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 574.5, "maximum": 574.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 574.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, POLATUZUMAB VEDOTIN 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9309", "type": "HCPCS"}], "standard_charges": [{"minimum": 471.43, "maximum": 471.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 471.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RELEUKO 1 MCG", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.04, "maximum": 2.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REMIMAZOLAM, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2249", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.0, "maximum": 8.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RETIFANLIMAB-DLWR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.16, "maximum": 113.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.35, "maximum": 32.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.41, "maximum": 49.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.16, "maximum": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SEZABY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2561", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.16, "maximum": 5.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SPESOLIMAB-SBZO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1747", "type": "HCPCS"}], "standard_charges": [{"minimum": 228.43, "maximum": 228.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 228.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, STIMUFEND, 0.5 MG", "code_information": [{"code": "Q5127", "type": "HCPCS"}], "standard_charges": [{"minimum": 1246.53, "maximum": 1246.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1246.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUSVIMO 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2779", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.41, "maximum": 306.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUTIMLIMAB-JOME, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1302", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.39, "maximum": 67.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3060", "type": "HCPCS"}], "standard_charges": [{"minimum": 170.81, "maximum": 170.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TEBENTAFUSP-TEBN, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9274", "type": "HCPCS"}], "standard_charges": [{"minimum": 792.46, "maximum": 792.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 792.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TREMELIMUMAB-ACTL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 516.2, "maximum": 516.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 516.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.99, "maximum": 29.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 93.69, "maximum": 93.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (MYLAN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3371", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.66, "maximum": 22.66, "estimated_discounted_cash": 62.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3372", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.95, "maximum": 24.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 274.66, "maximum": 274.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VINCRISTINE SUL LIP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9371", "type": "HCPCS"}], "standard_charges": [{"minimum": 12975.02, "maximum": 12975.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12975.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 18765.42, "maximum": 18765.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18765.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.62, "maximum": 27.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. (ANI), UP TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 12702.72, "maximum": 12702.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12702.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ACTHAR GEL TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 15533.54, "maximum": 15533.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15533.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 1863.9, "maximum": 1863.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1863.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.93, "maximum": 96.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.65, "maximum": 49.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 711.23, "maximum": 711.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 711.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CALASPARGASE PEGOL-MKNL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9118", "type": "HCPCS"}], "standard_charges": [{"minimum": 276.45, "maximum": 276.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 276.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.38, "maximum": 21.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.17, "maximum": 57.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.5, "maximum": 68.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.55, "maximum": 71.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 250.42, "maximum": 250.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"minimum": 1796.03, "maximum": 1796.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1796.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.78, "maximum": 152.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (FIASP)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1812", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.61, "maximum": 5.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (LYUMJEV)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1814", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.31, "maximum": 5.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 290.15, "maximum": 290.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.88, "maximum": 8.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 1212.07, "maximum": 1212.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1212.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 758.63, "maximum": 758.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 758.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 178.46, "maximum": 178.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 178.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MELOXICAM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1738", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.6, "maximum": 12.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 2312.84, "maximum": 2312.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2312.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.58, "maximum": 16.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 236.37, "maximum": 236.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 236.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.1, "maximum": 157.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 157.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.69, "maximum": 40.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 1234.83, "maximum": 1234.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1234.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"minimum": 1244.1, "maximum": 1244.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1244.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.26, "maximum": 2.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.8, "maximum": 53.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.56, "maximum": 6.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.72, "maximum": 11.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 642.92, "maximum": 642.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 642.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.16, "maximum": 104.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CERLIPONASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0567", "type": "HCPCS"}], "standard_charges": [{"minimum": 403.12, "maximum": 403.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 327.18, "maximum": 327.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.12, "maximum": 306.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1424.87, "maximum": 1424.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1424.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMICIZUMAB-KXWH 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7170", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.12, "maximum": 192.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 192.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.28, "maximum": 4.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.54, "maximum": 62.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.17, "maximum": 4.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.65, "maximum": 513.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 513.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., HAEGARDA 10 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0599", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.94, "maximum": 39.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"minimum": 283.05, "maximum": 283.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 283.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.16, "maximum": 1862.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1862.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.02, "maximum": 51.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.73, "maximum": 88.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.38, "maximum": 8.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.87, "maximum": 13.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 379.22, "maximum": 379.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 379.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.09, "maximum": 44.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.65, "maximum": 13.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RAVULIZUMAB-CWVZ 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1303", "type": "HCPCS"}], "standard_charges": [{"minimum": 841.18, "maximum": 841.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 841.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RETISERT, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 1134.3, "maximum": 1134.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1134.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ROLAPITANT, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2797", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.45, "maximum": 3.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.57, "maximum": 51.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 533.5, "maximum": 533.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 533.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.08, "maximum": 62.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.86, "maximum": 34.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRILURON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7332", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.95, "maximum": 38.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRIPTORELIN XR 3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3316", "type": "HCPCS"}], "standard_charges": [{"minimum": 11787.16, "maximum": 11787.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11787.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., VESTRONIDASE ALFA-VJBK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3397", "type": "HCPCS"}], "standard_charges": [{"minimum": 995.28, "maximum": 995.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 995.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., YUTIQ, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7314", "type": "HCPCS"}], "standard_charges": [{"minimum": 2006.49, "maximum": 2006.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2006.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.59, "maximum": 81.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT EPIDURAL PATCH", "code_information": [{"code": "62273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4394.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 411.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 296.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT PROC SACRO JNT", "code_information": [{"code": "4917096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7771.0, "discounted_cash": 5828.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT SACROILIAC JOINT", "code_information": [{"code": "27096", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 199.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 167.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SPINE DISK LMBR", "code_information": [{"code": "4917715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1868.0, "discounted_cash": 1401.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECT TRIGGER POINTS 3/>", "code_information": [{"code": "20553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 73.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4223.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1415.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 102.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 169.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 61.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTABLE BULK AGENT", "code_information": [{"code": "L8606", "type": "HCPCS"}, {"code": "8182614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1012.24, "maximum": 1012.24, "gross_charge": 5110.0, "discounted_cash": 3832.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1012.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTABLE BULK AGENT2", "code_information": [{"code": "L8606", "type": "HCPCS"}, {"code": "8182612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1012.24, "maximum": 1012.24, "gross_charge": 3777.0, "discounted_cash": 2832.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1012.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 139.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION ANISTREPLASE 30 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 10755.35, "maximum": 10755.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10755.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION ESTRONE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1435", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.71, "maximum": 56.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 212.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 212.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION EYE DRUG", "code_information": [{"code": "67028", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 330.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 136.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 1335.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 156.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 154.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 362.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 362.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 749.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 649.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 982.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 649.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27093", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 245.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 170.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 170.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR HIP X-RAY", "code_information": [{"code": "27095", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR MYELOGRAM", "code_information": [{"code": "62284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 300.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULDER X-RAY", "code_information": [{"code": "23350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 117.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 190.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 117.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 467.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 156.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST X-RAY", "code_information": [{"code": "25246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 230.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION GLATIRAMER ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1595", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.83, "maximum": 190.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 399.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 423.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 672.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 379.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3496.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1173.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO VOCAL CORD", "code_information": [{"code": "31513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 477.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 159.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 127.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION OF HIV PREP DRUG", "code_information": [{"code": "G0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PANTROPRAZOLE", "code_information": [{"code": "S0164", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.12, "maximum": 35.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION PX FOR ELBOW ARTHG", "code_information": [{"code": "24220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TORSEMIDE 10 MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3265", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.48, "maximum": 9.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TRABECTEDIN 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9352", "type": "HCPCS"}], "standard_charges": [{"minimum": 1283.55, "maximum": 1283.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1283.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 236.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 212.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 864.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 252.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 579.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 252.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1546.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 501.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1076.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 501.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1746.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 305.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 919.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 305.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 648.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 258.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 697.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 584.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 407.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 796.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 244.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 548.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 244.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 218.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION, ALEMTUZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0202", "type": "HCPCS"}], "standard_charges": [{"minimum": 8816.24, "maximum": 8816.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8816.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, AMINOCAPROIC ACID", "code_information": [{"code": "S0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.95, "maximum": 16.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, AVELUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 350.36, "maximum": 350.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 350.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BELINOSTAT, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.42, "maximum": 185.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BLINATUMOMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 552.13, "maximum": 552.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BUROSUMAB-TWZA 1M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0584", "type": "HCPCS"}], "standard_charges": [{"minimum": 1682.21, "maximum": 1682.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1682.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CARFILZOMIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 178.59, "maximum": 178.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 178.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOTETAN DISODIU", "code_information": [{"code": "S0074", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.84, "maximum": 46.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DALBAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0875", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.01, "maximum": 58.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DARATUMUMAB 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.05, "maximum": 234.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 234.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DEXAMETHASONE 9%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1095", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.48, "maximum": 4.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, EDARAVONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1301", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.74, "maximum": 82.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ELOTUZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9176", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.99, "maximum": 27.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FAMOTIDINE, 20 MG", "code_information": [{"code": "S0028", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.07, "maximum": 6.07, "estimated_discounted_cash": 199.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FOSPHENYTOIN SODI", "code_information": [{"code": "S0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 475.91, "maximum": 475.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FULVESTRANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9395", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.03, "maximum": 32.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, INCLISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1306", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.02, "maximum": 46.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, KHAPZORY, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0642", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.8, "maximum": 5.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, MEPOLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2182", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.71, "maximum": 115.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NAFCILLIN SODIUM", "code_information": [{"code": "S0032", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.32, "maximum": 59.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NECITUMUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9295", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.76, "maximum": 21.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NIVOLUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9299", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.92, "maximum": 117.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, OCRELIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.64, "maximum": 226.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 226.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2406", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.2, "maximum": 155.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERAMIVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2547", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.14, "maximum": 6.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERTUZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9306", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.51, "maximum": 58.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PIPERACILLIN SODI", "code_information": [{"code": "S0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.86, "maximum": 4.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RAMUCIRUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9308", "type": "HCPCS"}], "standard_charges": [{"minimum": 266.44, "maximum": 266.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RESLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2786", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.57, "maximum": 38.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RUCONEST", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0596", "type": "HCPCS"}], "standard_charges": [{"minimum": 127.09, "maximum": 127.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SILTUXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2860", "type": "HCPCS"}], "standard_charges": [{"minimum": 564.94, "maximum": 564.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 564.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SULFAMETHOXAZOLE", "code_information": [{"code": "S0039", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.61, "maximum": 41.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 41.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, TICARCILLIN DISOD", "code_information": [{"code": "S0040", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.76, "maximum": 38.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, TRILACICLIB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1448", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.73, "maximum": 19.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, UDENYCA 0.5 MG", "code_information": [{"code": "Q5111", "type": "HCPCS"}], "standard_charges": [{"minimum": 463.14, "maximum": 463.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 463.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ZARXIO", "code_information": [{"code": "Q5101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN ONE SU", "code_information": [{"code": "D2650", "type": "HCPCS"}], "standard_charges": [{"minimum": 971.65, "maximum": 971.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 971.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN TWO SU", "code_information": [{"code": "D2651", "type": "HCPCS"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 1 SU", "code_information": [{"code": "D2610", "type": "HCPCS"}], "standard_charges": [{"minimum": 1056.39, "maximum": 1056.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1056.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 2 SU", "code_information": [{"code": "D2620", "type": "HCPCS"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY TITANIUM", "code_information": [{"code": "D6624", "type": "HCPCS"}], "standard_charges": [{"minimum": 1335.97, "maximum": 1335.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14549.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14549.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4868.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX AC, PER SQ CM", "code_information": [{"code": "A2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 3666.73, "maximum": 3666.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3666.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX FS, PER SQ CM", "code_information": [{"code": "A2013", "type": "HCPCS"}], "standard_charges": [{"minimum": 3930.69, "maximum": 3930.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3930.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT30", "code_information": [{"code": "G0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 336.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 336.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT50", "code_information": [{"code": "G0426", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 475.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/ED TELECONSULT70", "code_information": [{"code": "G0427", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 674.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 674.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 15", "code_information": [{"code": "G0406", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 149.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 49.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 25", "code_information": [{"code": "G0407", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 261.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INPT/TELE FOLLOW UP 35", "code_information": [{"code": "G0408", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 381.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 381.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 127.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS ASPART PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321256", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS ASPART PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321256", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS BEAR JRNY II XR XLPE SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10326.0, "discounted_cash": 7744.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS BEARNG KNEE PLY MEDACTA CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6846.0, "discounted_cash": 5134.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2022.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 835.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1032.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1427.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1032.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 12945.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 893.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 599.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 959.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 599.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1055.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1152.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1634.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1152.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4616252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BIL", "code_information": [{"code": "4916252", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18212.0, "discounted_cash": 13659.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1261.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1067.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1603.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1067.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4616251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNI", "code_information": [{"code": "4916251", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19669.0, "discounted_cash": 14751.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 905.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1058.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1475.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1058.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND UNI", "code_information": [{"code": "4916253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20433.0, "discounted_cash": 15324.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1471.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1604.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2249.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1604.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 63599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1255.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1699.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2321.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1699.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS DETEMR PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS DETEMR PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321258", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS DEVICE FOR RT GUIDE OPEN", "code_information": [{"code": "49412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 294.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4617191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24502.0, "discounted_cash": 18376.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVA VENACAVA FILT", "code_information": [{"code": "4917191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 26461.0, "discounted_cash": 19845.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37191", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 33690.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 781.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1840.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2301.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1840.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS GLARG PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS GLARG PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS GLARGINE-YFGN PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321518", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS GLARGINE-YFGN PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321518", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS H REG 500U 20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321384", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS H REG 500U 20ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321384", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS LINR BEAR HUM ARTHROSRF CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18227.0, "discounted_cash": 13670.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS LISPRO PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321264", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS LISPRO PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321264", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS LV LD W/PM OR AICD", "code_information": [{"code": "4613225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 42197.0, "discounted_cash": 31647.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 664.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 310.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 574.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 310.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 626.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 345.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 601.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 345.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS N/R 70/30 PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS NPH HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321262", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS POLY INFNTY EVRLST CRSSLK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23202.0, "discounted_cash": 17401.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS REG HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321265", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS REG HUM PER 5U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321265", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4627.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1534.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS TIB PLY INFNTY BIOFM 3DSZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 66229.0, "discounted_cash": 49671.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS TUN IP CATH FOR DIAL OPN", "code_information": [{"code": "49421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 812.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 272.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS TUNN INTRAPER CATH", "code_information": [{"code": "4919418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 29329.0, "discounted_cash": 21996.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAD LEFT HRT PERC ART", "code_information": [{"code": "4613986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23927.0, "discounted_cash": 17945.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAD LEFT PERC ART/VEIN", "code_information": [{"code": "4613987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23927.0, "discounted_cash": 17945.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 282.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/PMGEN W/EXISDUALLDS", "code_information": [{"code": "4612505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 79074.0, "discounted_cash": 59305.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1995.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 667.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD AT", "code_information": [{"code": "4613206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21314.0, "discounted_cash": 15985.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PM W/TRNSV LD VE", "code_information": [{"code": "4613207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PMW/TRNSV LD A-V", "code_information": [{"code": "4613208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INS/RPL PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20167.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1074.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 503.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLC SPI NPG/RCVR POCKET", "code_information": [{"code": "63685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 23419.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1244.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 414.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLCM PRQ ELTRD RA PN EA", "code_information": [{"code": "64597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLCMT PRQ ELTRD RA PN 1", "code_information": [{"code": "64596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/RPLMT ELTRD RA SPI NSTIM", "code_information": [{"code": "784T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1327.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1318.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 441.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2841.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT AND REMOVE BONE PIN", "code_information": [{"code": "20650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 614.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3733.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1239.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3526.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1763.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 590.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH COMPLEX", "code_information": [{"code": "51703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 275.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 179.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATHETER", "code_information": [{"code": "51701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 793.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1907.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 597.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 198.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 534.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 531.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 773.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 531.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 643.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 643.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 351.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 571.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRODES FOR EEG", "code_information": [{"code": "95830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2500.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2500.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 624.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 799.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 624.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT EMERGENCY AIRWAY", "code_information": [{"code": "31500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2122.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 507.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3934.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1308.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2893.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 968.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2755.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 921.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT EYE SOCKET IMPLANT", "code_information": [{"code": "67550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3940.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1298.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1621.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 542.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 37947.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1703.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 570.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2887.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 969.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1823.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 616.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13298.0, "discounted_cash": 9973.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUM LNR BEAR ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8156.0, "discounted_cash": 6117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT HUMERAL STD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 49083.0, "discounted_cash": 36812.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 915.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 305.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6866.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6866.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2291.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT INTRAUTERINE DEVICE", "code_information": [{"code": "58300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 183.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT KNEE POLY UNI DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3505.0, "discounted_cash": 2628.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE REVIS EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16353.0, "discounted_cash": 12264.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE REVISION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT KNEE TS REV STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT LENS PROSTHESIS", "code_information": [{"code": "66985", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4854.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5393.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2786.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 927.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT LEVONORGESTREL IUS", "code_information": [{"code": "S4981", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6619.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2216.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 907.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 302.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MULTI-COMP PENIS PROS", "code_information": [{"code": "54405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2939.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 986.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 472.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 183.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 360.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 183.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3110.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 214.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 72.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 505.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 169.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 223.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15114.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3108.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1021.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3146.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1034.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1812.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1293.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 432.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9124.0, "discounted_cash": 6843.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1202.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1146.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1669.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1146.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1124.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 963.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1436.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 963.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 730.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 594.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 594.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT POLY ANKLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22780.0, "discounted_cash": 17085.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 591.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 751.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 591.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1209.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1154.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 387.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SCRW PLT LCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 665.0, "discounted_cash": 498.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT SELF-CONTD PROSTHESIS", "code_information": [{"code": "54401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2436.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1944.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2717.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1420.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2740.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 917.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2935.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 983.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3534.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1187.41, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2608.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 872.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2715.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 908.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2873.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE INFUSION DEVICE", "code_information": [{"code": "62360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1138.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 384.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 421.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20175.0, "gross_charge": 26900.0, "discounted_cash": 20175.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 17485.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 10760.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 20175.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SWANGANZ CATHETER", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "4613535", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20175.0, "gross_charge": 26900.0, "discounted_cash": 20175.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 17485.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 10760.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 20175.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2886.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 968.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TEMP BLADDER CATH", "code_information": [{"code": "51702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 909.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21906.0, "discounted_cash": 16429.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL ANY DJO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22396.0, "discounted_cash": 16797.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3709.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1250.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 714.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 804.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1139.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 804.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1510.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 502.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1158.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 855.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1334.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 855.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 16261.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 928.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 581.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 581.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1384.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 870.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1425.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 870.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 15172.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1191.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 660.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1123.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 660.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1298.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 752.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1258.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 752.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1207.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 506.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 959.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 506.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1280.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3954.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4684.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3954.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3653.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK SPHINCTER", "code_information": [{"code": "53445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2760.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 925.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1036.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 493.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT/BEARING POLY EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14242.0, "discounted_cash": 10681.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 52.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 376.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 427.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 246.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION DRUG DLVR IMPLANT", "code_information": [{"code": "11981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 226.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 122.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 144.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 755.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 479.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5077.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5077.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1701.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1439.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2001.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1439.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 646.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 192.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4273.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 557.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2388.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 800.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 2766.61, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2766.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2728.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSERTION PALATE PROSTHESIS", "code_information": [{"code": "42281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 589.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 272.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7068374", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 897.16, "gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 502.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 264.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 897.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 280.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7258516", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 897.16, "gross_charge": 2206.0, "discounted_cash": 1654.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 502.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 264.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 897.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 280.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSIT MLTIPLX STAIN CMPT", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "7270097", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 897.16, "gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 502.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 264.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 897.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 280.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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PLAN - PPO", "standard_charge_dollar": 111.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 771.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 252.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU EA MULTIPLEX STN/2", "code_information": [{"code": "88366", "type": "CPT"}, {"code": "7250238", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 771.08, "gross_charge": 1813.0, "discounted_cash": 1359.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 381.43, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 143.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 111.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 771.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 252.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION AUTO", "code_information": [{"code": "88367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 289.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 205.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 119.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 289.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ ANT SGM AQ DRG DEV 1+", "code_information": [{"code": "671T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2473.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2995.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1218.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 828.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 925.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1204.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1197.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 402.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOPROSTC VLV FEM VN", "code_information": [{"code": "744T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3258.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BREAST IMPLT SM D MAST", "code_information": [{"code": "19340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2771.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 932.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2477.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3700.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 4400.79, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4400.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], "standard_charges": [{"minimum": 4119.35, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4119.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5368.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1275.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1600.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 534.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1255.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 418.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2061.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 691.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1078.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC 5 YR+ W/O IMAGING", "code_information": [{"code": "36569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 339.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 329.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5393.0, "estimated_discounted_cash": 9373.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4854.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5393.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 298.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 442.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1967.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3907.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1297.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22869", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1586.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 426.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 26687.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 310.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4744.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1623.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 543.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1325.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1884.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1577.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1371.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1339.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1371.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3695.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT BRST IMPLT SEP D", "code_information": [{"code": "19342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2779.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 935.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1595.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34972.0, "estimated_discounted_cash": 65573.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34972.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3246.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1084.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3367.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1344.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1274.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PRQ RA SAC NSTIM", "code_information": [{"code": "786T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT A & V PM W/L VENT LEAD", "code_information": [{"code": "C7539", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT ATRIL PM W/L VENT LEAD", "code_information": [{"code": "C7537", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT BEAR PLY CNVNT HGH SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5866.0, "discounted_cash": 4399.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN EXT", "code_information": [{"code": "4917760", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9097.0, "discounted_cash": 6822.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT BILI DRAIN INT/EXT", "code_information": [{"code": "4917534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32267.0, "discounted_cash": 24200.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 42195.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1844.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 616.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT HUM LINR BEAR STRYK CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9868.0, "discounted_cash": 7401.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT HUM LNR BEARN TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10321.0, "discounted_cash": 7740.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT HUM RET REV AEQ ASC FLEX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8137734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14497.0, "discounted_cash": 10872.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT LD VEN LTVENT PREV", "code_information": [{"code": "4613221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21212.0, "discounted_cash": 15909.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT MOD TIB OSTEOREMEDIES CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11231.0, "discounted_cash": 8423.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT NONTUNNL CV CTH 5>", "code_information": [{"code": "4616556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5719.0, "discounted_cash": 4289.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT NONTUNNL CV CTH 5>", "code_information": [{"code": "4916556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6177.0, "discounted_cash": 4632.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PERC VAD R HRT VENOUS", "code_information": [{"code": "4613989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP<5 NO IMG", "code_information": [{"code": "6296568", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7208.0, "discounted_cash": 5406.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "4916569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5690.0, "discounted_cash": 4267.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC NO PRT/PMP>5 NO IMG", "code_information": [{"code": "6296510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5268.0, "discounted_cash": 3951.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "4916573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9777.0, "discounted_cash": 7332.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PICC W/IMG 5+YR", "code_information": [{"code": "6296573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9777.0, "discounted_cash": 7332.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 445.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1431.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 477.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34972.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34972.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1315.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "4613271", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 28156.0, "discounted_cash": 21117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TNL CV CTH5>WO PMP", "code_information": [{"code": "4616558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8930.0, "discounted_cash": 6697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TNL CV CTH5>WO PMP", "code_information": [{"code": "4916558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9646.0, "discounted_cash": 7234.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TRAN ELCTRD SNGL", "code_information": [{"code": "4612510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16039.0, "discounted_cash": 12029.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNLD PLEURAL CATH", "code_information": [{"code": "4912019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18823.0, "discounted_cash": 14117.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT TUNNL VAD 5>W PORT", "code_information": [{"code": "4916561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11255.0, "discounted_cash": 8441.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT VENT PM W/L VENT LEAD", "code_information": [{"code": "C7538", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/BEAR FLX CNG XLK ZIM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9255.0, "discounted_cash": 6941.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/BEAR HI CRSLK XLP SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10326.0, "discounted_cash": 7744.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/BEAR POLY X3 STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10326.0, "discounted_cash": 7744.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/BEAR VIT E ATTUN DPY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8260.0, "discounted_cash": 6195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/BEAR VIVACIT E ZIMM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10842.0, "discounted_cash": 8131.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/REDO NEUROSTIM 1 ARRAY", "code_information": [{"code": "61885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1944.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 652.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/REPL TEMP PM LEAD", "code_information": [{"code": "4613595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16039.0, "discounted_cash": 12029.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/RPL SQ DEFIB W/ELE", "code_information": [{"code": "4610319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 67371.0, "discounted_cash": 50528.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/RPLC AICD & LDS", "code_information": [{"code": "4613249", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 83291.0, "discounted_cash": 62468.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSRT/RPLC CARDIAC MODUL SYSTM", "code_information": [{"code": "4610408", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 174736.0, "discounted_cash": 131052.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3624.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1215.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2507.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 827.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTI HEXAMINOLEVULINATE HCL", "code_information": [{"code": "A9589", "type": "HCPCS"}], "standard_charges": [{"minimum": 5013.74, "maximum": 5013.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5013.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTILL ADSTILADRIN, TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9029", "type": "HCPCS"}], "standard_charges": [{"minimum": 232131.6, "maximum": 232131.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232131.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTILL PHARM RENAL PELVIS", "code_information": [{"code": "C9789", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTILL, BUPIVAC AND MELOXIC", "code_information": [{"code": "C9088", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.69, "maximum": 2.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTL AGNT VIA CHEST TBE INIT", "code_information": [{"code": "4910015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4868.0, "discounted_cash": 3651.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTLJ FECAL MICROBIOTA SSP", "code_information": [{"code": "780T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODIES", "code_information": [{"code": "86337", "type": "CPT"}, {"code": "7256042", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.21, "gross_charge": 276.0, "discounted_cash": 207.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN DRIP PER 5U PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321291", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN DRIP PER 5U PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}, {"code": "5321291", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.4, "maximum": 3.4, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1817", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.19, "maximum": 30.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN FREE", "code_information": [{"code": "83527", "type": "CPT"}, {"code": "7253527", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.12, "gross_charge": 222.0, "discounted_cash": 166.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 628.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 291.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 135.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 150.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 628.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 149.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1081.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 196.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 228.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 104.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 116.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1081.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 256.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 390.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 196.55, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 232.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 107.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 119.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 92.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOTAL", "code_information": [{"code": "83525", "type": "CPT"}, {"code": "7253525", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.35, "gross_charge": 213.0, "discounted_cash": 159.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN TOTAL/2", "code_information": [{"code": "83525", "type": "CPT"}, {"code": "7250211", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.35, "gross_charge": 168.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 1 HROID W/O IMG", "code_information": [{"code": "46945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1246.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 22193.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1393.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 467.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1623.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 543.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT THERAPEUTIC RESTORATION", "code_information": [{"code": "D2941", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.07, "maximum": 179.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTAKE ACT W/MED EXAM", "code_information": [{"code": "G2076", "type": "HCPCS"}], "standard_charges": [{"minimum": 752.15, "maximum": 752.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 752.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2INX2IN 25CM PER SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241495", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 168.26, "maximum": 168.26, "gross_charge": 6099.0, "discounted_cash": 4574.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2INX2IN 25CM PER SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241495", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 168.26, "maximum": 168.26, "gross_charge": 6099.0, "discounted_cash": 4574.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 10X12.5 PER SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023184", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 2339.0, "discounted_cash": 1754.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 10X12.5 PER SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023184", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 2339.0, "discounted_cash": 1754.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 5X5 SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023185", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 5X5 SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023185", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 996.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 8X10 SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAY 8X10 SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023186", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAYR 4X10 PER SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023183", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 1885.0, "discounted_cash": 1413.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAYR 4X10 PER SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4023183", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 1885.0, "discounted_cash": 1413.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAYR MTRX SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4032750", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 47622.0, "discounted_cash": 35716.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 2LAYR MTRX SQ CM", "code_information": [{"code": "Q4104", "type": "HCPCS"}, {"code": "4032750", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 187.88, "maximum": 187.88, "gross_charge": 47622.0, "discounted_cash": 35716.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 4INX5IN 120CM PR SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241496", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 168.26, "maximum": 168.26, "gross_charge": 1492.0, "discounted_cash": 1119.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA 4INX5IN 120CM PR SQ CM", "code_information": [{"code": "Q4108", "type": "HCPCS"}, {"code": "8241496", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 168.26, "maximum": 168.26, "gross_charge": 1492.0, "discounted_cash": 1119.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRML REGEN TEMPL", "code_information": [{"code": "Q4105", "type": "HCPCS"}, {"code": "4032751", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 96.13, "maximum": 96.13, "gross_charge": 973.0, "discounted_cash": 729.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRML REGEN TEMPL", "code_information": [{"code": "Q4105", "type": "HCPCS"}, {"code": "4032751", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 96.13, "maximum": 96.13, "gross_charge": 973.0, "discounted_cash": 729.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTEGRA MSH 2LAY SQ CM", "code_information": [{"code": "C9363", "type": "HCPCS"}, {"code": "4023189", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17499.0, "discounted_cash": 13124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTEGRA MSH 2LAY SQ CM", "code_information": [{"code": "C9363", "type": "HCPCS"}, {"code": "4023189", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 17499.0, "discounted_cash": 13124.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTEN OUTPT SVS,MIN 9 PR 7 D", "code_information": [{"code": "G0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 2898.5, "maximum": 2898.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2898.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS BEHAVE THER CARDIO DX", "code_information": [{"code": "G0446", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 470.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 470.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 470.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 470.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "1990062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2010062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2120062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2150062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2160062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2180062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2300062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE INTERMED", "code_information": [{"code": "2320062", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "1990022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 10511.0, "discounted_cash": 7883.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "2010022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 10511.0, "discounted_cash": 7883.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENSIVE CARE UNIT", "code_information": [{"code": "2120022", "type": "CDM"}, {"code": "200", "type": "RC"}], "standard_charges": [{"gross_charge": 10511.0, "discounted_cash": 7883.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTENTIONAL REPLANTATION", "code_information": [{"code": "D3470", "type": "HCPCS"}], "standard_charges": [{"minimum": 1009.2, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1009.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2713.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 909.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL FIXATION", "code_information": [{"code": "21110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2591.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1033.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2143.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 861.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 555.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 316.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERFER BETA-1B .3MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1830", "type": "HCPCS"}, {"code": "5321477", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1706.13, "maximum": 1706.13, "gross_charge": 1216.0, "discounted_cash": 912.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1706.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFER BETA-1B .3MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1830", "type": "HCPCS"}, {"code": "5321477", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 1706.13, "maximum": 1706.13, "gross_charge": 1216.0, "discounted_cash": 912.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1706.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9213", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.73, "maximum": 153.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9214", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.55, "maximum": 123.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-N3 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9215", "type": "HCPCS"}], "standard_charges": [{"minimum": 99.57, "maximum": 99.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFACON-1 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9212", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.05, "maximum": 32.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1826", "type": "HCPCS"}], "standard_charges": [{"minimum": 6497.11, "maximum": 6497.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6497.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON GAMMA 1-B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9216", "type": "HCPCS"}], "standard_charges": [{"minimum": 26008.3, "maximum": 26008.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26008.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFYL, 1 MG", "code_information": [{"code": "Q4171", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.54, "maximum": 44.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERIM CROWN", "code_information": [{"code": "D2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.06, "maximum": 490.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 490.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERIM IMPLANT ABUTMENT", "code_information": [{"code": "D6051", "type": "HCPCS"}], "standard_charges": [{"minimum": 479.17, "maximum": 479.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 479.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERIM PONTIC", "code_information": [{"code": "D6253", "type": "HCPCS"}], "standard_charges": [{"minimum": 890.67, "maximum": 890.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 890.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERIM RETAINER CROWN", "code_information": [{"code": "D6793", "type": "HCPCS"}], "standard_charges": [{"minimum": 796.3, "maximum": 796.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 796.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERNAL NERVE REVISION", "code_information": [{"code": "64727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 648.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERNAL ROOT REPAIR", "code_information": [{"code": "D3333", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.89, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 402.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERRO EVAL CARDIAC MODULJ", "code_information": [{"code": "418T", "type": "CPT"}], "standard_charges": [{"minimum": 218.36, "maximum": 218.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 218.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICDS SS IP", "code_information": [{"code": "576T", "type": "CPT"}], "standard_charges": [{"minimum": 72.07, "maximum": 72.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 72.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 118.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"minimum": 120.5, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 113.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 37.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"minimum": 97.67, "maximum": 97.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERROG W/O PRGRMG IPNSS", "code_information": [{"code": "93153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 188.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 188.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS", "code_information": [{"code": "93151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 317.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROG&PRGRMG IPNSS POLYSM", "code_information": [{"code": "93152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 575.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 575.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS DEV", "code_information": [{"code": "272T", "type": "CPT"}], "standard_charges": [{"minimum": 113.22, "maximum": 113.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS W/PGRMG", "code_information": [{"code": "273T", "type": "CPT"}], "standard_charges": [{"minimum": 259.71, "maximum": 259.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 259.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 125.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 184.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 184.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 62.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10300.58, "maximum": 21766.66, "estimated_discounted_cash": 48432.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15464.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11093.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10716.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10300.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17237.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21766.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20481.78, "maximum": 43281.04, "estimated_discounted_cash": 95922.42, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24235.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22057.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21308.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20481.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34275.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43281.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7772.92, "maximum": 16425.33, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11733.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8370.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8086.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7772.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13007.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16425.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5048.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3863.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1298.62, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINE IMAGING", "code_information": [{"code": "78290", "type": "CPT"}, {"code": "5208290", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1304.33, "gross_charge": 6095.0, "discounted_cash": 4571.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 432.56, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 515.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1173.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1304.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 977.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1097.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 212.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 212.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.5 CM/<", "code_information": [{"code": "12051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1809.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 617.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 341.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 2.6-5.0 CM", "code_information": [{"code": "12052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 726.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 122.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 381.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 122.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1396.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 205.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 701.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 205.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 5.1-7.5 CM", "code_information": [{"code": "12053", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 783.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 438.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 801.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1523.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT 2.5CM/<", "code_information": [{"code": "12041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 317.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT >30.0CM", "code_information": [{"code": "12047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1282.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 663.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT12.6-20", "code_information": [{"code": "12045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 996.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 500.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT2.6-7.5", "code_information": [{"code": "12042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3359.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 713.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 374.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 191.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 605.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 191.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [{"code": "12044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 780.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 12.6-20", "code_information": [{"code": "12035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 878.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 2.5 CM/<", "code_information": [{"code": "12031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6499.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 316.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 2.6-7.5", "code_information": [{"code": "12032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10236.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 693.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 119.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 20.1-30", "code_information": [{"code": "12036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1025.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT 7.6-12.5", "code_information": [{"code": "12034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 747.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 404.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/TR/EXT >30.0 CM", "code_information": [{"code": "12037", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1191.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 591.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTR HEMOSTASIS FASTCATH", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8247250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 958.0, "discounted_cash": 718.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH CATH AVANTI", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4032850", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH CATH AVANTI 2", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 209.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH INPUT-TS", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH PERIPH PINNACL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH PINNACLE R/O", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4023190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2299.0, "discounted_cash": 1724.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH SUPER", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1268.0, "discounted_cash": 951.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTR SHTH ULTIMUM", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 169.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACARD ABL ARRHY", "code_information": [{"code": "93655", "type": "CPT"}, {"code": "4613659", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27821.0, "gross_charge": 33254.0, "discounted_cash": 24940.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12145.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 21615.1, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 13301.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27821.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1082.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 24940.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 361.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACARD ECHO", "code_information": [{"code": "93662", "type": "CPT"}, {"code": "4613662", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "gross_charge": 12316.0, "discounted_cash": 9237.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 8005.4, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 4926.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 9237.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRAN ADM AGNT ADDL", "code_information": [{"code": "4911651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4997.0, "discounted_cash": 3747.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACRAN ADM THERA AGNT", "code_information": [{"code": "4911650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21632.0, "discounted_cash": 16224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5350.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1804.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4925.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1649.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "65", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10964.79, "maximum": 23170.22, "estimated_discounted_cash": 85475.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15505.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11808.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11407.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10964.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18349.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23170.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21825.38, "maximum": 46120.27, "estimated_discounted_cash": 148120.83, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25322.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23504.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22706.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21825.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36523.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46120.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "66", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7427.79, "maximum": 15696.03, "estimated_discounted_cash": 80489.08, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10970.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7999.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7727.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7427.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12430.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15696.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 491.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 491.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [{"code": "21", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57453.61, "maximum": 121408.01, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 104248.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 61873.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 59772.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57453.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96146.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 121408.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "20", "type": "MS-DRG"}], "standard_charges": [{"minimum": 85400.09, "maximum": 180463.06, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 137564.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 91970.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 88846.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 85400.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 142913.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 180463.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "22", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34484.32, "maximum": 72870.49, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 65464.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37137.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35876.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34484.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57707.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72870.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8262.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2749.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15080.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15080.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5009.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10320.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10320.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3454.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16241.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16241.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5434.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7945.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2660.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13208.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13208.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4419.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAFRACTION TRACK MOTION", "code_information": [{"code": "G6017", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 447.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 447.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAGASTRIC HYPOTHERMIA", "code_information": [{"code": "M0100", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRALUMINL DILATN ESOPH", "code_information": [{"code": "74360", "type": "CPT"}, {"code": "4904361", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 5365.0, "discounted_cash": 4023.75, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL BIOPSY", "code_information": [{"code": "30100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2478.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 812.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR FOMIVIRSEN NA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1452", "type": "HCPCS"}], "standard_charges": [{"minimum": 3793.0, "maximum": 3793.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3793.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19623.31, "maximum": 41466.97, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20403.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21133.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20415.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19623.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32838.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41466.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11774.42, "maximum": 24881.1, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12003.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12680.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12249.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11774.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19703.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24881.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 606.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 437.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST CAVITY", "code_information": [{"code": "353T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 338.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 338.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 753.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 753.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOR COMPREHENSIVE SERIES", "code_information": [{"code": "D0210", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.68, "maximum": 113.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF INTER PLT", "code_information": [{"code": "D5958", "type": "HCPCS"}], "standard_charges": [{"minimum": 3955.64, "maximum": 3955.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3955.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF MOD PALAT", "code_information": [{"code": "D5959", "type": "HCPCS"}], "standard_charges": [{"minimum": 1248.81, "maximum": 1248.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1248.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL OCCLUSAL FILM", "code_information": [{"code": "D0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.76, "maximum": 33.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL EA ADD", "code_information": [{"code": "D0230", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.53, "maximum": 14.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL FIRST", "code_information": [{"code": "D0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.9, "maximum": 28.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PLACE OF FIX DEV", "code_information": [{"code": "D7998", "type": "HCPCS"}], "standard_charges": [{"minimum": 3238.12, "maximum": 3238.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3238.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAUT COPPER CONTRACEPTIVE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 3985.04, "maximum": 3985.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3985.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1243.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 413.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRCRD EP 3DMAP", "code_information": [{"code": "93613", "type": "CPT"}, {"code": "4613613", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 35030.0, "discounted_cash": 26272.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24028.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1029.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 342.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANTIBDY", "code_information": [{"code": "86340", "type": "CPT"}, {"code": "7255536", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 57.2, "gross_charge": 185.0, "discounted_cash": 138.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM EST PATIENT", "code_information": [{"code": "92012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRM OPH EXAM NEW PATIENT", "code_information": [{"code": "92002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 164.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 102.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9974", "type": "HCPCS"}], "standard_charges": [{"minimum": 279.54, "maximum": 279.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 38610.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 596.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 553.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 816.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 553.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 29627.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 850.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 995.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1389.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 995.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 34122.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1117.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4020.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4797.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4020.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH SHTH STD", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4877.0, "discounted_cash": 3657.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO COOK CHECKFLO LG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 736.0, "discounted_cash": 552.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO COOK CHECKFLO XLG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2522.0, "discounted_cash": 1891.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO FLEXOR CHECKFLO", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8241509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 652.0, "discounted_cash": 489.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO LONG GI TUBE", "code_information": [{"code": "4907782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6271.0, "discounted_cash": 4703.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO LONG GI TUBE", "code_information": [{"code": "4917782", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6271.0, "discounted_cash": 4703.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 106.2, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO NDL DIAL-CIRC+S&I", "code_information": [{"code": "4916901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9653.0, "discounted_cash": 7239.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 435.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 584.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 435.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO PEEL AWAY", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10623.0, "discounted_cash": 7967.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SAFESHEATH II CLS", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8174938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1993.0, "discounted_cash": 1494.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHEATH PRELUDE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174942", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4674.0, "discounted_cash": 3505.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHEATH PROTRIEVE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174935", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20438.0, "discounted_cash": 15328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH CATH BRITE TP", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH COR PINNALCE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8182688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1188.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH COR PINNCL GW", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8182689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1252.0, "discounted_cash": 939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH DILATOR DIREX", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8177120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4321.0, "discounted_cash": 3240.75, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH GLIDE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "4032851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 664.0, "discounted_cash": 498.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SHTH STEERABL", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8174939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7226.0, "discounted_cash": 5419.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO SUPRAPUBC ONE-STEP", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8182690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 794.0, "discounted_cash": 595.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO TRANSFEMORAL BLN", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3526.0, "discounted_cash": 2644.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 531.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1234.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 942.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTROD SHTH SPLITTABL W/SDPRT", "code_information": [{"code": "C1892", "type": "HCPCS"}, {"code": "8174937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3226.0, "discounted_cash": 2419.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER PERFORMER W/RDQ BND", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8174936", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 561.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRPHLNGEAL JOINT SPACR", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "8130123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1356.87, "maximum": 1356.87, "gross_charge": 7583.0, "discounted_cash": 5687.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1356.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY 1ST", "code_information": [{"code": "37252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 22799.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 313.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 880.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1073.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 880.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRVASC US NONCORONARY ADDL", "code_information": [{"code": "37253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 17892.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 106.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 205.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 106.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTUBATION", "code_information": [{"code": "5500205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3390.0, "discounted_cash": 2542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 161.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 141.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 215.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 72.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO MAP OF SENT LYMPH NODE", "code_information": [{"code": "38900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 494.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1532.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 933.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 531.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1379.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1532.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1165.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 396.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 IOBENGUANE", "code_information": [{"code": "A9582", "type": "HCPCS"}], "standard_charges": [{"minimum": 21037.0, "maximum": 21037.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21037.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 IOFLUPANE", "code_information": [{"code": "A9584", "type": "HCPCS"}], "standard_charges": [{"minimum": 10671.68, "maximum": 10671.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10671.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-131 IOBENGUANE 1MCI", "code_information": [{"code": "A9590", "type": "HCPCS"}], "standard_charges": [{"minimum": 1458.29, "maximum": 1458.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1458.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315349", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE 30ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315349", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE5% 8ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315350", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE/K IODIDE5% 8ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315350", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOL ANTERIOR CHAMBER", "code_information": [{"code": "V2630", "type": "HCPCS"}, {"code": "8122064", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 529.2, "gross_charge": 3679.0, "discounted_cash": 2759.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOL IRIS SUPPORT", "code_information": [{"code": "V2631", "type": "HCPCS"}, {"code": "8122065", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 529.2, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOL MONOFOCAL 3PC 6.0", "code_information": [{"code": "V2631", "type": "HCPCS"}, {"code": "8122066", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 529.2, "gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOL POSTERIOR CHMBR", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "8122044", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 529.2, "gross_charge": 9241.0, "discounted_cash": 6930.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IONM IN OPERATNG ROOM 15 MIN", "code_information": [{"code": "95940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP HEMODIALYSIS", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600976", "type": "CDM"}, {"code": "801", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 257.54, "gross_charge": 6429.0, "discounted_cash": 4821.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP HEMODIALYSIS", "code_information": [{"code": "90935", "type": "CPT"}, {"code": "5600976", "type": "CDM"}, {"code": "821", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 257.54, "gross_charge": 6429.0, "discounted_cash": 4821.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST LOW 45", "code_information": [{"code": "99253", "type": "CPT"}], "standard_charges": [{"minimum": 362.84, "maximum": 362.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 362.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CNSLTJ NEW/EST MOD 60", "code_information": [{"code": "99254", "type": "CPT"}], "standard_charges": [{"minimum": 503.75, "maximum": 503.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 503.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST HI 80", "code_information": [{"code": "99255", "type": "CPT"}], "standard_charges": [{"minimum": 678.19, "maximum": 678.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 678.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IP/OBS CONSLTJ NEW/EST SF 35", "code_information": [{"code": "99252", "type": "CPT"}], "standard_charges": [{"minimum": 258.8, "maximum": 258.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPILIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9228", "type": "HCPCS"}], "standard_charges": [{"minimum": 653.99, "maximum": 653.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 653.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM .02%2.5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM .02%2.5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331231", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7645", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.38, "maximum": 8.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7644", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.23, "maximum": 1.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM PER DOSE IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331238", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM PER DOSE IH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}, {"code": "5331238", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 14.83, "maximum": 14.83, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUMNAS.03%30MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 603.0, "discounted_cash": 452.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUMNAS.03%30MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 603.0, "discounted_cash": 452.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUMNAS.06%15MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331236", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUMNAS.06%15MLSP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331236", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRBESARTAN 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306051", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRBESARTAN 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306051", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5765.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan 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"plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON SUCROSE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1756", "type": "HCPCS"}, {"code": "5321529", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.84, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON SUCROSE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1756", "type": "HCPCS"}, {"code": "5321529", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.84, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGANT OPHTH 30ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331241", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGANT OPHTH 30ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331241", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "4546523", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.8, "gross_charge": 554.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATE VASC ACCESS DEV", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "4546523", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.8, "gross_charge": 554.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIGATION MAXILLARY SINUS", "code_information": [{"code": "31000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 406.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 78.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 224.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 78.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDER", "code_information": [{"code": "51700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1564.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 49.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 49.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRIGATION SPHENOID SINUS", "code_information": [{"code": "31002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 694.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 227.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISAVUCONAZONIUM 186MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306080", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 614.0, "discounted_cash": 460.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISAVUCONAZONIUM 186MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306080", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 614.0, "discounted_cash": 460.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISAVUCONAZONIUM PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1833", "type": "HCPCS"}, {"code": "5321533", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISAVUCONAZONIUM PER1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1833", "type": "HCPCS"}, {"code": "5321533", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [{"code": "62", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19070.89, "maximum": 40299.62, "estimated_discounted_cash": 158350.14, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27032.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20538.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19840.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19070.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31914.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40299.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [{"code": "61", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29922.81, "maximum": 63231.33, "estimated_discounted_cash": 246246.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40168.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32224.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31130.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 29922.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50074.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63231.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC", "code_information": [{"code": "63", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15235.44, "maximum": 32194.75, "estimated_discounted_cash": 122129.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21996.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16407.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15850.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15235.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25495.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32194.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP GRAFT", "code_information": [{"code": "15740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total 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"plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 182.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "7256341", "type": "CDM"}, {"code": "300", "type": 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HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISLET CELL TISSUE TRANSPLANT", "code_information": [{"code": "S2102", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, 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"RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISONIAZID 100MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306097", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISONIAZID 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306100", "type": 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14353.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18124.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "695", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12413.66, "maximum": 26231.91, "estimated_discounted_cash": 55699.95, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18138.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13368.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12914.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12413.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20773.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26231.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7477.72, "maximum": 15801.53, "estimated_discounted_cash": 39632.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9643.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8053.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7779.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7477.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12513.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15801.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1055.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1128.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 474.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1764.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 590.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1905.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 639.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2557.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1225.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 506.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2025.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 679.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1241.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 515.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1417.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 583.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2019.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 677.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 729.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 389.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 195.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 350.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 389.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 290.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY HISTOTRIPSY W/IMAGE", "code_information": [{"code": "C9790", "type": "HCPCS"}], "standard_charges": [{"minimum": 5011.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 712.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 342.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 257.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 641.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 712.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 500.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 876.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 402.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 321.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 788.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 876.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 672.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR 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"case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1519.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/DRAINAGE", "code_information": [{"code": "29871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1904.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2304.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 775.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3407.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29873", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1991.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 668.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1986.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 664.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 14140.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1835.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 616.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2404.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 808.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2288.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2437.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 819.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 27141.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2073.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 17205.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1998.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2532.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 851.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3095.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1034.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 33072.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2284.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2785.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 936.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2349.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 790.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29887", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2775.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 933.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 28690.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3565.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1195.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29889", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4485.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1506.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCP HARV", "code_information": [{"code": "S2112", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMP 4 VW MIN", "code_information": [{"code": "73564", "type": "CPT"}, {"code": "4903570", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 139.6, "gross_charge": 3152.0, "discounted_cash": 2364.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 125.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 139.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 131.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE EXTENSION STEM ZIMM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41510.0, "discounted_cash": 31132.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE FEM UNI ZK GENE UNI SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": 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928.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KT PMP TANDMHEART TANDMLNG CAN", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4033016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 237305.0, "discounted_cash": 177978.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT PUMP TANDEMHEART TANDMLUNG", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4033014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 182117.0, "discounted_cash": 136587.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT PUNCTURE JUGULAR PED", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "8082181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9036.0, "discounted_cash": 6777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT RC PRGM STIMR WAVEWRITER", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8082443", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 6271.0, "discounted_cash": 4703.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KT REPAIR MINI TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17750.0, "discounted_cash": 13312.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KT REPAIR SYNDESMOSIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8082451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13482.0, "discounted_cash": 10111.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KT REPR MED PATL FEM LIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15356.0, "discounted_cash": 11517.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT REVISION INTRATH CATH", "code_information": [{"code": "C1755", "type": "HCPCS"}, {"code": "8082457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5680.0, "discounted_cash": 4260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT RPR TGHTRP SYND KNTLS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13708.0, "discounted_cash": 10281.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SEALANT PROGEL PLEURL", "code_information": [{"code": "C2615", "type": "HCPCS"}, {"code": "8038504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7796.0, "discounted_cash": 5847.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SHTH INTRO TRANSRADL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8178117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.0, "discounted_cash": 332.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SHTH INTRO W/GW/DIL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8082516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 701.0, "discounted_cash": 525.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SNARE VAS ATRIEVE", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "4033006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1993.0, "discounted_cash": 1494.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SONABLATE HIFU DISPOSABLE", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8178130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19317.0, "discounted_cash": 14487.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT STAPLE BN FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23711.0, "discounted_cash": 17783.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KT STNT P STR RX PUSHER", "code_information": [{"code": "C2625", "type": "HCPCS"}, {"code": "8062027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1724.0, "discounted_cash": 1293.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KT SUBCHND CMPL FOOT/ANK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30927.0, "discounted_cash": 23195.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KT TAVR HRT VLV SAPIEN TRNCTH", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8143270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 335589.0, "discounted_cash": 251691.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KT TIP EXPNDR NARRW BAS", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8178123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1101.0, "discounted_cash": 825.75, "setting": "both", "billing_class": "facility"}]}, {"description": "KYLEENA, 19.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 4262.31, "maximum": 4262.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4262.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7799.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2618.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8977.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8977.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3013.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6523.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2181.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7102.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2371.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7523", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7524", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 933.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/ IVUS OR OCT", "code_information": [{"code": "C7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7526", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L RINGERS 1000ML IRR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5414070", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L RINGERS 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "5412550", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 9.83, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L RINGERS 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "5412550", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 9.83, "gross_charge": 129.0, "discounted_cash": 96.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L RINGERS 3000ML IRR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5414080", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 409.0, "discounted_cash": 306.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L RINGERS 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "5412545", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 9.83, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L RINGERS 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}, {"code": "5412545", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.83, "maximum": 9.83, "gross_charge": 173.0, "discounted_cash": 129.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1633.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 546.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L&D EPIDURAL", "code_information": [{"code": "3702299", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 2995.0, "discounted_cash": 2246.25, "setting": "both", "billing_class": "facility"}]}, {"description": "L/S MYELO W/INJ", "code_information": [{"code": "4902304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6784.0, "discounted_cash": 5088.0, "setting": "both", "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.79, "methodology": "fee 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{"description": "LABETALOL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306321", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306321", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306325", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306325", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}, {"code": "5321682", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABETALOL PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}, {"code": "5321682", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER PORC INDIRECT", "code_information": [{"code": "D2962", "type": "HCPCS"}], "standard_charges": [{"minimum": 1218.46, "maximum": 1218.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1218.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN DIRECT", "code_information": [{"code": "D2960", "type": "HCPCS"}], "standard_charges": [{"minimum": 507.05, "maximum": 507.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 507.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN INDIRECT", "code_information": [{"code": "D2961", "type": "HCPCS"}], "standard_charges": [{"minimum": 846.98, "maximum": 846.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}, {"code": "7250022", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.4, "maximum": 102.83, "gross_charge": 388.0, "discounted_cash": 291.0, "setting": 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"HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV3 VACCINE INTRANASAL", "code_information": [{"code": "90660", "type": "CPT"}], "standard_charges": [{"minimum": 88.98, "maximum": 88.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAIV4 VACCINE INTRANASAL", "code_information": [{"code": "90672", "type": "CPT"}], "standard_charges": [{"minimum": 105.41, "maximum": 105.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAM FACETC/FRMT ARTHRD LUM 1", "code_information": [{"code": "63052", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 927.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 311.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT CRV", "code_information": [{"code": "63045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4706.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1576.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT LUMBAR", "code_information": [{"code": "63047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4043.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1357.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC & FORAMOT THRC", "code_information": [{"code": "63046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4495.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1507.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETEC &FORAMOT EA ADDL", "code_information": [{"code": "63048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 756.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACTC/FRMT ARTHRD LUM EA", "code_information": [{"code": "63053", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM W/CORDOTOMY 1STG THRC", "code_information": [{"code": "63197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6252.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2094.23, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.74, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL CERVICAL", "code_information": [{"code": "63043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 719.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL LUMBAR", "code_information": [{"code": "63044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 668.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE CERVICAL", "code_information": [{"code": "63040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5024.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1683.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE LUMBAR", "code_information": [{"code": "63042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4731.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1584.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306345", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306345", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315494", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMIVUDINE 150MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315494", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306347", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306347", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306346", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306346", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE QUANT", "code_information": [{"code": "80175", "type": "CPT"}, {"code": "7250040", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.26, "gross_charge": 424.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANOLIN 30GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336118", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LANOLIN 30GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336118", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LANREOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1930", "type": "HCPCS"}], "standard_charges": [{"minimum": 183.74, "maximum": 183.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 183.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANSOPRAZOLE 30MG PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315492", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANSOPRAZOLE 30MG PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315492", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANSOPRAZOLE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306352", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANSOPRAZOLE 30MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306352", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANTHANUM CARB 500MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306361", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LANTHANUM CARB 500MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306361", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP CLOSE ENTEROSTOMY", "code_information": [{"code": "44227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5973.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1998.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4813.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1611.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY W/PROCTECTOMY", "code_information": [{"code": "44211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7631.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2550.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4390.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1467.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ENTERECTOMY", "code_information": [{"code": "44202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5014.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1679.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ENTEROLYSIS", "code_information": [{"code": "44180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 49873.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3335.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1118.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 563.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6680.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2244.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "estimated_discounted_cash": 50275.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6285.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2105.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3948.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1319.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2362.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR INIT", "code_information": [{"code": "49650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 30612.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1584.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ING HERNIA REPAIR RECUR", "code_information": [{"code": "49651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 24568.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2067.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 465.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 156.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 24041.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1404.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 469.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2369.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 793.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL ADD-ON", "code_information": [{"code": "44213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 667.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 223.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4633.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1550.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPH HER RPR W/MESH", "code_information": [{"code": "43282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "estimated_discounted_cash": 39210.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6244.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2089.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN REPAIR", "code_information": [{"code": "43281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5544.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1854.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6276.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2096.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP PLACE GASTR ADJ DEVICE", "code_information": [{"code": "43770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4089.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1370.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5475.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1830.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6886.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2293.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7060.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2357.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7647.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2557.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REPLACE GASTR ADJ DEVICE", "code_information": [{"code": "43773", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4636.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 860.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REVISE GASTR ADJ DEVICE", "code_information": [{"code": "43771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4636.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3069.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1496.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 500.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ ALL PARTS", "code_information": [{"code": "43774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "estimated_discounted_cash": 31645.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3488.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1170.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RMVL GASTR ADJ DEVICE", "code_information": [{"code": "43772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3448.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1157.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP SLEEVE GASTRECTOMY", "code_information": [{"code": "43775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "estimated_discounted_cash": 41013.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3984.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1333.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 674.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4563.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1529.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4546.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1524.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL CYST", "code_information": [{"code": "50541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 30547.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3325.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL MASS", "code_information": [{"code": "50542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4206.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1416.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/EXPLR", "code_information": [{"code": "47564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4062.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1362.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/GRAPH", "code_information": [{"code": "47563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 28218.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2613.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2820.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 945.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2327.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 781.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO LIGATE SPERMATIC VEIN", "code_information": [{"code": "55550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 27125.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5008.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1676.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4594.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1548.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5542.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1854.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5395.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1807.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4827.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1618.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5887.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1982.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4853.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1626.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO SLING OPERATION", "code_information": [{"code": "51992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3045.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1016.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6387.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2133.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7300.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2447.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2706.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 908.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-ASST VAG HYSTERECTOMY", "code_information": [{"code": "58550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3229.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1076.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4067.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1353.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST COMPLEX", "code_information": [{"code": "58553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4090.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1361.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST INCL T/O", "code_information": [{"code": "58552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3587.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1196.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST W/T/O COMPL", "code_information": [{"code": "58554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4767.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1586.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY", "code_information": [{"code": "47562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 30790.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2405.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 807.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [{"code": "418", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18358.93, "maximum": 38795.15, "estimated_discounted_cash": 132758.28, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24184.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19771.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19099.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18358.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30722.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38795.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25899.6, "maximum": 54729.7, "estimated_discounted_cash": 158797.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35479.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27892.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26944.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25899.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43341.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54729.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14823.03, "maximum": 31323.26, "estimated_discounted_cash": 126369.94, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17943.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15963.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15421.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14823.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24805.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31323.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY", "code_information": [{"code": "58545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3300.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1098.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC NEPHRECTOMY", "code_information": [{"code": "50546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4360.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1462.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4100.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1371.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4317.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1449.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY APPENDECTOMY", "code_information": [{"code": "44970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 26661.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2195.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ASPIRATION", "code_information": [{"code": "49322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1366.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 457.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY BIOPSY", "code_information": [{"code": "49321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1256.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 421.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY EXCISE LESIONS", "code_information": [{"code": "58662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2611.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 869.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2671.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 888.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FUNDOPLASTY", "code_information": [{"code": "43280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3901.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1307.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2110.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2738.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 918.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPH NODE BIOP", "code_information": [{"code": "38570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1884.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2407.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 807.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3271.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1092.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYSIS", "code_information": [{"code": "58660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2502.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIECTOMY", "code_information": [{"code": "54690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2388.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 801.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIOPEXY", "code_information": [{"code": "54692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2747.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 921.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY PYELOPLASTY", "code_information": [{"code": "50544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4487.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1504.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY REMOVE ADNEXA", "code_information": [{"code": "58661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2385.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 794.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SALPINGOSTOMY", "code_information": [{"code": "58673", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2898.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 964.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3844.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1288.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [{"code": "57425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 62393.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3555.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1184.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL BLOCK", "code_information": [{"code": "58671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1365.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY TUBAL CAUTERY", "code_information": [{"code": "58670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1365.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY URETEROLITHOTOMY", "code_information": [{"code": "50945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3516.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1178.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2397.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 804.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2789.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 935.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4476.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1498.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2973.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 990.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2375.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 797.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1038.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4287.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1435.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "estimated_discounted_cash": 62718.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4331.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1452.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT SMPL STOT", "code_information": [{"code": "55867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 74096.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3804.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1276.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7067.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2356.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGE DISPOSABLE UNDERPAD", "code_information": [{"code": "T4541", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 655.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 359.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 618.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 359.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 543.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 821.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1084.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 821.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 543.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 485.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 326.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 346.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1931", "type": "HCPCS"}], "standard_charges": [{"minimum": 142.01, "maximum": 142.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARVAL THERAPY EA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5336175", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2276.0, "discounted_cash": 1707.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 144.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 144.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4419.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1476.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5156.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1712.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5640.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1883.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5445.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1819.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6141.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2042.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6143.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2043.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4691.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1559.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4031.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1347.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1128.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 378.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/VC INJ + SCOPE", "code_information": [{"code": "31571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 901.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 829.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 122.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 415.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 122.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 118.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 545.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 524.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 175.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 584.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 195.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIAGNOSTIC", "code_information": [{"code": "5501575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3086.0, "discounted_cash": 2314.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 404.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 706.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 435.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 238.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BIOPSY", "code_information": [{"code": "31535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 685.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 230.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BX & OP SCOPE", "code_information": [{"code": "31536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 761.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 254.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/EXC OF TUMOR", "code_information": [{"code": "31540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 873.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 765.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 255.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 720.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 441.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 435.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 158.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 323.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 158.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1234.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 412.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP W/TUMR EXC + SCOPE", "code_information": [{"code": "31541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 18914.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 952.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 318.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURG PENIS LESION(S)", "code_information": [{"code": "54057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 360.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 169.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY ANAL LESIONS", "code_information": [{"code": "46917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 473.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 328.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 328.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1281.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 467.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2369.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 951.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1829.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 951.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 21604.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2524.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 958.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1889.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 958.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67039", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3469.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1153.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3742.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1245.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAT RETINACULAR RELEASE OPEN", "code_information": [{"code": "27425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1690.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LATANOPROST .005%2.5MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331365", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 798.0, "discounted_cash": 598.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LATANOPROST .005%2.5MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331365", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 798.0, "discounted_cash": 598.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAUP", "code_information": [{"code": "S2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LD ACUITY X4 SPRL L 4677", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "4008569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23688.0, "discounted_cash": 17766.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LD ACUITY X4 SPRL L 4678", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "4000378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24482.0, "discounted_cash": 18361.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LD ACUITY X4 SPRL S 4674", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "4008564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16718.0, "discounted_cash": 12538.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LD ACUITY X4 SPRL S 4675", "code_information": [{"code": "C1900", "type": "HCPCS"}, {"code": "4008574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 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"discounted_cash": 3635.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 738.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LE ART IMAGING UNI/LTD", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "5067201", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 440.33, "gross_charge": 4215.0, "discounted_cash": 3161.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 440.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD PACEMAKER", "code_information": [{"code": "C1898", "type": "HCPCS"}, {"code": "4008658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4068.0, "discounted_cash": 3051.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD QUANTITATIVE", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "7253655", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.93, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFLUNOMIDE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306363", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFLUNOMIDE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306363", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 180.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/ GRAFT", "code_information": [{"code": "21145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5628.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5628.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1890.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-1 PIECE W/O GRAFT", "code_information": [{"code": "21141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4844.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1626.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/ GRAFT", "code_information": [{"code": "21146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5877.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5877.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1974.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W/O GRAFT", "code_information": [{"code": "21142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4970.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1669.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6183.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6183.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2076.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/O GRAFT", "code_information": [{"code": "21143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5123.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5123.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1720.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5988.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1994.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6589.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2195.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7866.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7866.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2622.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10213.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10213.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3406.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9419.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3141.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7093.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2364.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3338.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 158.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 81.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 94.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 43.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 158.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA AB", "code_information": [{"code": "86713", "type": "CPT"}, {"code": "7256171", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.03, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.73, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA AB/2", "code_information": [{"code": "86713", "type": "CPT"}, {"code": "7256724", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.03, "gross_charge": 387.0, "discounted_cash": 290.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA PNEUMOPHILA", "code_information": [{"code": "87278", "type": "CPT"}, {"code": "7257279", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.17, "gross_charge": 589.0, "discounted_cash": 441.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHEN METACARPAL/FINGER", "code_information": [{"code": "26568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3417.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1133.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4129.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1386.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS OR ULNA", "code_information": [{"code": "25391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3650.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1226.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND TENDON", "code_information": [{"code": "26478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2427.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 807.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3311.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1107.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3085.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1031.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4330.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1453.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1857.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2419.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 813.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3242.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1088.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENS BIFOCAL SPECIALITY", "code_information": [{"code": "V2299", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", 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{"description": "LEV 2 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0381", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 936.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 753.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.0, "methodology": "case rate"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 450.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 494.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", 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"methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 4 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 1607.0, "maximum": 3100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2111.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.59, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1661.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1725.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1607.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2454.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3100.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEV 5 HOSP TYPE B ED VISIT", "code_information": [{"code": "G0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 1607.0, "maximum": 3100.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 24.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 22.5, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 13.59, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1661.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1725.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1607.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2454.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3100.0, 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{"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7614", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL1.25MG/3MLIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331376", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL1.25MG/3MLIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331376", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVAMISOLE 50 MG", "code_information": [{"code": "S0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.31, "maximum": 13.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACET PER10MGPMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}, {"code": "5321697", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACET PER10MGPMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}, {"code": "5321697", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "gross_charge": 2.0, "discounted_cash": 1.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACET250MG/2.5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315493", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACET250MG/2.5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315493", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM", "code_information": [{"code": "80177", "type": "CPT"}, {"code": "7250016", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.26, "gross_charge": 408.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306406", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306406", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM PER 1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5321694", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM PER10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}, {"code": "5321696", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM PER10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}, {"code": "5321696", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM500MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315478", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM500MG/5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315478", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOBUNOLOL .5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331370", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 423.0, "discounted_cash": 317.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOBUNOLOL .5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": 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{"description": "LEVOTHYROXIN .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306459", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306459", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306467", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXIN .3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306467", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOTHYROXINE NOS PER 10MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0650", "type": "HCPCS"}, {"code": "5321693", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVOTHYROXINE NOS PER 10MCG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0650", "type": "HCPCS"}, {"code": "5321693", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDO/EPI/TETRA 3ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5336207", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDO/EPI/TETRA 3ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5336207", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDO/PRILOC 2.5% 5GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336204", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE", "code_information": [{"code": "80176", "type": "CPT"}, {"code": "7253610", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.72, "gross_charge": 294.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 30GM GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336198", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 5ML GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336202", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 2% 6ML GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336236", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% 4ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336216", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% 50ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% PATCH TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336240", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 4% PATCH TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336240", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE 5% 35GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE 5% TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336213", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE D5W PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}, {"code": "5321753", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE D5W PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}, {"code": "5321753", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.1, "maximum": 0.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "5321754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "5321754", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG PF IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "5321756", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.39, "discounted_cash": 0.29, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG PF IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "5321756", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.39, "discounted_cash": 0.29, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG W/EPI IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2004", "type": "HCPCS"}, {"code": "5321759", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE PER 1MG W/EPI IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2004", "type": "HCPCS"}, {"code": "5321759", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.12, "discounted_cash": 0.09, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 100 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315505", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 100 LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315505", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 15MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315506", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE VISC 2% 15MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315506", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE2%UROJET 20MLGL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336230", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5509.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5509.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1845.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1920.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 634.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2051.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 685.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.07, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 34979.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 915.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5233.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5233.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1751.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1645.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 546.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 17489.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1401.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 469.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2217.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 733.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 73970.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1337.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 446.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4751.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4751.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1586.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4045.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1374.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1417.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 472.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION OF HEMORRHOID(S)", "code_information": [{"code": "46221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6399.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 704.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 348.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6214.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6214.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2081.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2712.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2619.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 875.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2682.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 899.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1871.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2632.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 878.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 803.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 452.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1565.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3199.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1058.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LILETTA, 52 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 3285.61, "maximum": 3285.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3285.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 234.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 234.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 75.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 772.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40839.84, "maximum": 86300.64, "estimated_discounted_cash": 376441.34, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 53456.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 43981.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 42488.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 40839.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 68343.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 86300.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMIT ORAL EVAL PROBLM FOCUS", "code_information": [{"code": "D0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.33, "maximum": 89.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88036", "type": "CPT"}], "standard_charges": [{"minimum": 71.97, "maximum": 383.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 71.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 79.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED AUTOPSY", "code_information": [{"code": "88037", "type": "CPT"}], "standard_charges": [{"minimum": 57.45, "maximum": 341.48, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 57.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 63.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADOLESCENT", "code_information": [{"code": "D8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 3536.18, "maximum": 3536.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3536.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADULT", "code_information": [{"code": "D8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 3435.32, "maximum": 3435.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3435.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX PRIMARY", "code_information": [{"code": "D8010", "type": "HCPCS"}], "standard_charges": [{"minimum": 2222.55, "maximum": 2222.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2222.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX TRANSITION", "code_information": [{"code": "D8020", "type": "HCPCS"}], "standard_charges": [{"minimum": 2627.22, "maximum": 2627.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2627.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9951", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.69, "maximum": 156.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 156.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMITED VISUAL FIELD XM", "code_information": [{"code": "92081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", 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"discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "4153725", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.07, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "4173725", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.07, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306674", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306674", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 300MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306675", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 300MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306675", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 450MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306676", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM 450MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306676", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM CARB 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306678", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM CARB 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306678", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM300MG/5ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315485", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHIUM300MG/5ML 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315485", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITHOTRIPSY", "code_information": [{"code": "3080590", "type": "CDM"}, {"code": "790", "type": "RC"}], "standard_charges": [{"gross_charge": 28254.0, "discounted_cash": 21190.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4364.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1477.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5249.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1754.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/ASH", "code_information": [{"code": "2M", "type": "CPT"}], "standard_charges": [{"minimum": 455.97, "maximum": 1909.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 455.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 506.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1909.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/NASH", "code_information": [{"code": "3M", "type": "CPT"}], "standard_charges": [{"minimum": 455.97, "maximum": 1909.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 455.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 506.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1909.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 346.35, "maximum": 1909.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 346.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 384.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1909.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 453.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}, {"code": "7250255", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 120.02, "maximum": 668.29, "gross_charge": 1329.0, "discounted_cash": 996.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 120.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 133.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 668.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 158.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 695.89, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 626.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 695.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING STATIC", "code_information": [{"code": "78201", "type": "CPT"}, {"code": "5208201", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 749.55, "gross_charge": 2618.0, "discounted_cash": 1963.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 294.61, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 287.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 674.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 749.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 569.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 839.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 347.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 305.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 755.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 839.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 621.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 206.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [{"code": "5", "type": "MS-DRG"}], "standard_charges": [{"minimum": 111899.86, "maximum": 236461.01, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 152935.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 120509.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 116415.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 111899.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 187259.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 236461.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [{"code": "6", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50325.36, "maximum": 106344.96, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 69145.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 54197.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 52356.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 50325.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 84217.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 106344.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER/SPLEEN IMAG STATIC", "code_information": [{"code": "78215", "type": "CPT"}, {"code": "5208215", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 775.21, "gross_charge": 4727.0, "discounted_cash": 3545.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 338.96, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 293.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 697.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 775.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 579.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 189.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER/SPLEEN VASC FLOW", "code_information": [{"code": "78216", "type": "CPT"}, {"code": "5208216", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 503.37, "gross_charge": 4224.0, "discounted_cash": 3168.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 336.0, 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"setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306749", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM .5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306749", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306752", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306752", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306756", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306756", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM PER 2MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2060", "type": "HCPCS"}, {"code": "5321894", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4.26, "maximum": 4.26, "gross_charge": 141.0, "discounted_cash": 105.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM PER 2MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2060", "type": "HCPCS"}, {"code": "5321894", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.26, "maximum": 4.26, "gross_charge": 141.0, "discounted_cash": 105.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM2MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315538", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM2MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315538", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 29.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306754", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306759", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306759", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306757", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOSARTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306757", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 175.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW BACK DISK SURGERY", "code_information": [{"code": "63030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3351.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1125.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10237.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW DENSITY LIPOPROTEIN(LDL)", "code_information": [{"code": "S2120", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1554.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1554.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 495.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"minimum": 291.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 24.73, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXT INFANT AP&LAT", "code_information": [{"code": "73592", "type": "CPT"}, {"code": "4903591", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.06, "gross_charge": 2246.0, "discounted_cash": 1684.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 90.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [{"code": "493", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19510.0, "maximum": 58162.92, "estimated_discounted_cash": 307383.76, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19510.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20233.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 29641.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28635.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 27524.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46060.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58162.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [{"code": "492", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19510.0, "maximum": 84204.47, "estimated_discounted_cash": 276003.14, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19510.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20233.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42913.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 41456.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39847.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66683.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84204.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC", "code_information": [{"code": "494", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19510.0, "maximum": 46017.07, "estimated_discounted_cash": 235920.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19510.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20233.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23451.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22655.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21776.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36442.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46017.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWER JAW BONE GRAFT", "code_information": [{"code": "21215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2881.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3414.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4839.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3414.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOWR EXTREMITY PROSTHES NOS", "code_information": [{"code": "L5999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306779", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306779", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306783", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 25MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306783", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306774", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOXAPINE FOR INHALATION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2062", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.34, "maximum": 58.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LP-PLA2 (PLAC)", "code_information": [{"code": "83698", "type": "CPT"}, {"code": "7253643", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 175.65, "gross_charge": 275.0, "discounted_cash": 206.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 76.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 23.3, "maximum": 128.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2677.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3085.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1025.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3039.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1010.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3314.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1103.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LT VENT ASSIST DEV TANDEM", "code_information": [{"code": "4614002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBIPROSTONE 24MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306795", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBIPROSTONE 24MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306795", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBIPROSTONE 8MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBIPROSTONE 8MCG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306794", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUMB BENDNG 2 OR 3 VWS", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "4902121", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.88, "gross_charge": 2106.0, "discounted_cash": 1579.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 95.58, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 163.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 181.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUMIZYME INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 748.28, "maximum": 748.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 748.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG BX PLUG W/DEL SYS", "code_information": [{"code": "C2613", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF PARTICULATE", "code_information": [{"code": "78580", "type": "CPT"}, {"code": "5208580", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 819.35, "gross_charge": 6875.0, "discounted_cash": 5156.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 385.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 349.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 737.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 819.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFF", "code_information": [{"code": "78598", "type": "CPT"}, {"code": "5208589", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1248.76, "gross_charge": 6858.0, "discounted_cash": 5143.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 887.12, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 457.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1123.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1248.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 861.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFER", "code_information": [{"code": "78597", "type": "CPT"}, {"code": "5208598", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 770.59, "gross_charge": 5147.0, "discounted_cash": 3860.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 422.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 286.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 693.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 770.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 546.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 178.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT", "code_information": [{"code": "7", "type": "MS-DRG"}], "standard_charges": [{"minimum": 135471.3, "maximum": 296999.89, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 135471.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 151361.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 146220.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 140548.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 235201.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 296999.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16257.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16257.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5448.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11638.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11638.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3894.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12536.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12536.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4196.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17212.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17212.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5758.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUNG VENT&PERF IMAGING", "code_information": [{"code": "78582", "type": "CPT"}, {"code": "5208583", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1290.73, "gross_charge": 14021.0, "discounted_cash": 10515.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 971.75, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 487.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1161.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1290.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 923.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 299.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}, {"code": "5208579", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 718.89, "gross_charge": 4991.0, "discounted_cash": 3743.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 393.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 278.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 646.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 718.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5268.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5268.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1762.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LURASIDONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306797", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LURASIDONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306797", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LURASIDONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306798", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LURASIDONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306798", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 335.0, "discounted_cash": 251.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUSUTROMBOPAG 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306792", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3662.0, "discounted_cash": 2746.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUSUTROMBOPAG 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306792", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3662.0, "discounted_cash": 2746.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTEINING HORMONE", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "7253002", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 70.25, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 DOTATAT THER", "code_information": [{"code": "A9513", "type": "HCPCS"}], "standard_charges": [{"minimum": 1208.49, "maximum": 1208.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1208.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 VIPIVOTIDE", "code_information": [{"code": "A9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 984.09, "maximum": 984.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 984.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LWR XTR VASC STDY BILAT", "code_information": [{"code": "93924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 496.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 496.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME AMP PROBE/2", "code_information": [{"code": "87476", "type": "CPT"}, {"code": "7257136", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "gross_charge": 543.0, "discounted_cash": 407.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.95, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.05, "methodology": "fee 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PROCEDURES WITH CC", "code_information": [{"code": "821", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24295.53, "maximum": 51340.05, "estimated_discounted_cash": 103767.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33601.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26164.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25276.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24295.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40657.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51340.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "820", "type": "MS-DRG"}], "standard_charges": [{"minimum": 63650.67, "maximum": 134503.32, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 80458.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 68547.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 66219.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63650.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 106516.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134503.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "822", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13067.01, "maximum": 27612.54, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18655.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14072.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13594.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13067.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21867.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27612.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "841", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17705.58, "maximum": 37414.53, "estimated_discounted_cash": 40435.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23639.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19067.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18420.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17705.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29629.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37414.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35108.37, "maximum": 74189.2, "estimated_discounted_cash": 162253.63, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45248.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37809.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 36525.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35108.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58752.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 74189.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24588.56, "maximum": 51959.27, "estimated_discounted_cash": 104622.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33437.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26480.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25580.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24588.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41147.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 51959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49758.83, "maximum": 105147.8, "estimated_discounted_cash": 130809.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 65009.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 53587.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 51766.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 49758.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 83269.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 105147.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "825", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14645.04, "maximum": 30947.14, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20109.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15771.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15236.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14645.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24507.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30947.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10965.87, "maximum": 23172.51, "estimated_discounted_cash": 40435.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15701.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11809.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11408.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10965.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18350.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23172.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 241.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 115.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS + LAVAGE W CATHETERS", "code_information": [{"code": "D7871", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4370.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYNECHIA", "code_information": [{"code": "30560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 555.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 379.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL LESION(S)", "code_information": [{"code": "56441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, 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{"description": "Laser Treatment Of Open Wound, Each Additional 20 Sq Cm", "code_information": [{"code": "492T", "type": "CPT"}], "standard_charges": [{"minimum": 336.82, "maximum": 336.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 336.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Laser Treatment Of Open Wound, First 20 Sq Cm Or Less", "code_information": [{"code": "491T", "type": "CPT"}], "standard_charges": [{"minimum": 450.76, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.76, "methodology": "fee 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{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21779.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20934.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35032.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44237.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [{"code": "483", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30083.43, "maximum": 63570.75, "estimated_discounted_cash": 251815.58, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35264.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32397.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31297.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30083.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50343.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63570.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITH CC/MCC", "code_information": [{"code": "707", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21709.26, "maximum": 45874.88, "estimated_discounted_cash": 94568.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26450.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23379.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22585.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21709.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 36329.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45874.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16650.67, "maximum": 35185.34, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19321.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17931.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17322.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16650.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27864.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35185.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "507", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19604.86, "maximum": 41427.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27905.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21113.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20396.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19604.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32807.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41427.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "508", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16435.78, "maximum": 34731.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22141.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17700.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17099.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16435.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27504.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34731.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23015.96, "maximum": 48636.13, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28597.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24786.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23944.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23015.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38516.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48636.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11748.37, "maximum": 24826.06, "estimated_discounted_cash": 115929.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13879.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12652.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12222.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11748.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19660.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24826.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26016.81, "maximum": 54977.38, "estimated_discounted_cash": 227901.91, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37137.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28018.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27066.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26016.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43537.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 54977.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49885.81, "maximum": 105416.13, "estimated_discounted_cash": 263088.16, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 73975.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 53723.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 51899.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 49885.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 83481.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 105416.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18264.51, "maximum": 38595.63, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24155.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19669.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19001.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18264.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30564.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38595.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14642.87, "maximum": 30942.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18766.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15769.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15233.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14642.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24504.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30942.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4503.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1505.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4717.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1578.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4574.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1529.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4750.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1587.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5069.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1693.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4717.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1578.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAKENA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1726", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.21, "maximum": 78.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALE CONDOM", "code_information": [{"code": "A4267", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALE SLING PROCEDURE", "code_information": [{"code": "53440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2741.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 919.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALE VACUUM ERECTION SYSTEM", "code_information": [{"code": "L7900", "type": "HCPCS"}], "standard_charges": [{"minimum": 968.73, "maximum": 968.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 968.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR > 1.25 CM", "code_information": [{"code": "D7441", "type": "HCPCS"}], "standard_charges": [{"minimum": 1780.05, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1780.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR EXC TO 1.25 CM", "code_information": [{"code": "D7440", "type": "HCPCS"}], "standard_charges": [{"minimum": 878.53, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 878.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12275.83, "maximum": 25940.65, "estimated_discounted_cash": 157026.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16958.32, "methodology": "case 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19756.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24947.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19987.97, "maximum": 42237.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28593.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21525.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20794.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19987.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33448.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42237.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "756", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9691.3, "maximum": 22028.11, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9691.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11226.32, "methodology": "case 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"methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8687.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8350.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13973.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17645.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAMMARY IMP", "code_information": [{"code": "L8600", "type": "HCPCS"}, {"code": "8153500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3025.79, "maximum": 3025.79, "gross_charge": 3459.0, "discounted_cash": 2594.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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PLAN - HMO", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 106.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANDIBLE GRAFT", "code_information": [{"code": "D7950", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4782.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR DENTURE PROSTH", "code_information": [{"code": "D5935", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 7808.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7808.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR FLANGE PROSTHESIS", "code_information": [{"code": "D5934", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 7808.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7808.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR PART DENTURE FLEX", "code_information": [{"code": "D5226", "type": "HCPCS"}], "standard_charges": [{"minimum": 2218.03, "maximum": 2218.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANGANESE", "code_information": [{"code": "83785", "type": "CPT"}, {"code": "7253785", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.08, "gross_charge": 645.0, "discounted_cash": 483.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 47.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 55.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 25.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 28.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULAT PALM CORD POST INJ", "code_information": [{"code": "26341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE FINGER W/ANESTH", "code_information": [{"code": "26340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1338.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 453.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE WRIST W/ANESTHES", "code_information": [{"code": "25259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1619.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF HIP JOINT", "code_information": [{"code": "27275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 679.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE", "code_information": [{"code": "22505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANNITOL 20% 250ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412580", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANNITOL 20% 500ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412585", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANNITOL FOR INHALER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7665", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.0, "maximum": 14.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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{"code": "5321962", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.56, "discounted_cash": 0.42, "setting": "both", "billing_class": "facility"}]}, {"description": "MANUAL BLOOD COUNT", "code_information": [{"code": "85032", "type": "CPT"}, {"code": "4105012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.35, "gross_charge": 298.0, "discounted_cash": 223.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.35, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.5, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "MANUAL BLOOD COUNT", "code_information": [{"code": "85032", "type": "CPT"}, {"code": "4175010", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.35, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.35, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.26, "estimated_discounted_cash": 455.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 34.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO COMMUNITY", "code_information": [{"code": "G9152", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO PHYSICIAN", "code_information": [{"code": "G9153", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPCP DEMO STATE", "code_information": [{"code": "G9151", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAPLE SYRUP UR DS MNTR QUAN", "code_information": [{"code": "381U", "type": "CPT"}], "standard_charges": [{"minimum": 39.71, "maximum": 39.71, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARAVIROC 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306930", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARAVIROC 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306930", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARKER FIDUCIAL DISP", "code_information": [{"code": "A4648", "type": "HCPCS"}, {"code": "8182907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1577.38, "discounted_cash": 1183.04, "setting": "both", "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASS SPEC TNDM MS NES", "code_information": [{"code": "83789", "type": "CPT"}, {"code": "7250039", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.45, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 37.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST MOD RAD", "code_information": [{"code": "19307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4292.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1436.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4442.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1488.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4181.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1395.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MAST SIMPLE COMPLETE", "code_information": [{"code": "19303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3487.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1169.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18944.07, "maximum": 44184.64, "estimated_discounted_cash": 97826.34, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18944.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22518.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21753.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20909.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34990.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44184.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15926.83, "maximum": 39547.39, "estimated_discounted_cash": 140821.41, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15926.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20154.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19470.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18714.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31318.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39547.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY SLEEVE", "code_information": [{"code": "L8010", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.51, "maximum": 100.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERS TWO STEP", "code_information": [{"code": "S3904", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3729.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1235.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3990.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1319.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4694.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1560.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4075.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1348.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2607.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 864.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3461.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOTOMY EXPL DRG ABSC DP", "code_information": [{"code": "19020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1150.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 557.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRION 1 SQ CM", "code_information": [{"code": "Q4201", "type": "HCPCS"}], "standard_charges": [{"minimum": 395.29, "maximum": 395.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 395.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRISTEM MICROMATRI 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023911", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRISTEM MICROMATRI 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023911", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRISTM MCRMTRX 500MG PER 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023927", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 6351.0, "discounted_cash": 4763.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRISTM MCRMTRX 500MG PER 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023927", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 6351.0, "discounted_cash": 4763.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRIX BONE IMP ALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRIX DERMAL ALLOAID DM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4020548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11359.0, "discounted_cash": 8519.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRSTM MCRMTRX 1000MG PER 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023938", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRSTM MCRMTRX 1000MG PER 1MG", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "4023938", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX ACEL DERM SCAFFLD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4023886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71830.0, "discounted_cash": 53872.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX ACEL MICRONZ PRTCL", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023885", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 8118.0, "discounted_cash": 6088.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX ACEL MICRONZ PRTCL", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023885", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 8118.0, "discounted_cash": 6088.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX BN CEL VIVIGEN FORM 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28500.0, "discounted_cash": 21375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN CELL OSTEOCEL PRO LRG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4028531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43884.0, "discounted_cash": 32913.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN CELL OSTEOCEL PRO MED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4028530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24525.0, "discounted_cash": 18393.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN CELL VIVIGN 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8132977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13018.0, "discounted_cash": 9763.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN FIBERGRFT MED 6.25CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 23750.0, "discounted_cash": 17812.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN OSTEOCELPLUS 10CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4013653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17153.0, "discounted_cash": 12864.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN OSTEOCELPLUS 1CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4013651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5815.0, "discounted_cash": 4361.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN OSTEOCELPLUS 5CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4013652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50597.0, "discounted_cash": 37947.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX BN VIABL CELL BIO4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39383.0, "discounted_cash": 29537.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX CARTILAG EXTRACELL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4023891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11026.0, "discounted_cash": 8269.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX COLLAGEN XENMATRIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4023888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 143941.0, "discounted_cash": 107955.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX DURA DUREPAIR", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13411.0, "discounted_cash": 10058.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX DURAL DURAGEN PLUS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13518.0, "discounted_cash": 10138.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX OASIS 5CMX7CM PER SQ CM", "code_information": [{"code": "Q4124", "type": "HCPCS"}, {"code": "4023932", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 35.21, "maximum": 6955.0, "gross_charge": 367.0, "discounted_cash": 275.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX OASIS 5CMX7CM PER SQ CM", "code_information": [{"code": "Q4124", "type": "HCPCS"}, {"code": "4023932", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 35.21, "maximum": 6955.0, "gross_charge": 367.0, "discounted_cash": 275.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX SUTUR DURAGEN DURL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4023925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14457.0, "discounted_cash": 10842.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MATRX WND ACEL PLST SURG", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023909", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27499.0, "discounted_cash": 20624.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX WND ACEL PLST SURG", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4023909", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27499.0, "discounted_cash": 20624.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX WND FLOWABLE 1CC", "code_information": [{"code": "Q4114", "type": "HCPCS"}, {"code": "4023910", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 5716.05, "maximum": 5716.05, "gross_charge": 30073.0, "discounted_cash": 22554.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5716.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MATRX WND FLOWABLE 1CC", "code_information": [{"code": "Q4114", "type": "HCPCS"}, {"code": "4023910", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5716.05, "maximum": 5716.05, "gross_charge": 30073.0, "discounted_cash": 22554.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5716.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAX MRI CAPTURE & INTERPRETE", "code_information": [{"code": "D0369", "type": "HCPCS"}], "standard_charges": [{"minimum": 1682.46, "maximum": 1682.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1682.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAX MRI IMAGE CAPTURE", "code_information": [{"code": "D0385", "type": "HCPCS"}], "standard_charges": [{"minimum": 1252.52, "maximum": 1252.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1252.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND CAPT & INTERP", "code_information": [{"code": "D0370", "type": "HCPCS"}], "standard_charges": [{"minimum": 432.59, "maximum": 432.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 432.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND IMAGE CAPTURE", "code_information": [{"code": "D0386", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.9, "maximum": 355.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 355.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT COMPOUND", "code_information": [{"code": "D7710", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7675.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7675.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT SIMPLE", "code_information": [{"code": "D7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6452.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLA OR MANDIBLE RESECTIO", "code_information": [{"code": "D7490", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 13792.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13792.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLARY PART DENTURE FLEX", "code_information": [{"code": "D5225", "type": "HCPCS"}], "standard_charges": [{"minimum": 2218.03, "maximum": 2218.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLARY SINUSOTOMY", "code_information": [{"code": "D7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 1447.18, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1447.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL FIXATION", "code_information": [{"code": "21100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1306.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 274.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 757.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 274.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL PROSTHESIS", "code_information": [{"code": "D5999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MC PERF SPECT WM EF 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GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 27.16, "maximum": 149.1, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 27.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 30.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1873.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2005.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2125.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 196.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 196.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD DOCUMENT VISIT BY NPP", "code_information": [{"code": "G0454", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD INR TEST REVIE INTER MGMT", "code_information": [{"code": "G0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 153.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 51.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MD SERVICE REQUIRED FOR PMD", "code_information": [{"code": "G0372", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3335.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1701.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MDI TREATMENT", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5502105", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.9, "gross_charge": 532.0, "discounted_cash": 399.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASLES/MUMPS/RUB VACCIJ", "code_information": [{"code": "90707", "type": "CPT"}, {"code": "5321992", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 375.92, "maximum": 375.92, "gross_charge": 725.0, "discounted_cash": 543.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASLES/MUMPS/RUB VACCIJ", "code_information": [{"code": "90707", "type": "CPT"}, {"code": "5321992", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 375.92, "maximum": 375.92, "gross_charge": 725.0, "discounted_cash": 543.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 416.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 173.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 28.18, "maximum": 28.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECASERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2170", "type": "HCPCS"}], "standard_charges": [{"minimum": 488.05, "maximum": 488.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 488.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}, {"code": "5504670", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.76, "gross_charge": 501.0, "discounted_cash": 375.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 645.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 424.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 688.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 424.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMVL OBSTRTN GTUBE", "code_information": [{"code": "4919460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6383.0, "discounted_cash": 4787.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHLORETHAMINE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 1220.28, "maximum": 1220.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1220.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306968", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306968", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306975", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG CTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306975", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306972", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECLIZINE TAB 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306972", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 363.19, "maximum": 2002.21, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 363.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 403.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2002.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 135.0, "maximum": 568.95, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 145.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 161.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 568.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 197.21, "maximum": 2002.21, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 197.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 219.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2002.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 475.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 52.87, "maximum": 455.16, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 52.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 455.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ABORTION INC ALL EX DRUG", "code_information": [{"code": "S0199", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX BUPRE ORAL", "code_information": [{"code": "G2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 1089.08, "maximum": 1089.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1089.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX IMPLANT", "code_information": [{"code": "G2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 20579.87, "maximum": 20579.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20579.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX INJECT", "code_information": [{"code": "G2069", "type": "HCPCS"}], "standard_charges": [{"minimum": 7596.05, "maximum": 7596.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7596.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX METH WK", "code_information": [{"code": "G2067", "type": "HCPCS"}], "standard_charges": [{"minimum": 971.31, "maximum": 971.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 971.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX NO DRUG", "code_information": [{"code": "G2074", "type": "HCPCS"}], "standard_charges": [{"minimum": 772.9, "maximum": 772.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 772.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH INIT 15MIN", "code_information": [{"code": "97802", "type": "CPT"}, {"code": "6560036", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.52, "gross_charge": 210.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED NUTRTN TH REEVAL 15MN", "code_information": [{"code": "97803", "type": "CPT"}, {"code": "6567803", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.34, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3280.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 349.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 387.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3280.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1189.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 126.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"maximum": 63.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED TX INSERT/REMOVE IMP", "code_information": [{"code": "G2072", "type": "HCPCS"}], "standard_charges": [{"minimum": 21498.19, "maximum": 21498.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21498.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED TX NALTREXONE", "code_information": [{"code": "G2073", "type": "HCPCS"}], "standard_charges": [{"minimum": 6230.15, "maximum": 6230.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6230.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED TX REMOVE IMPLANT", "code_information": [{"code": "G2071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1886.07, "maximum": 1886.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1886.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "1990008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2010008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2050008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2120008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2150008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2160008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2180008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2300008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MED/SURG WITH TELEMETRY", "code_information": [{"code": "2320008", "type": "CDM"}, {"code": "206", "type": "RC"}], "standard_charges": [{"gross_charge": 7191.0, "discounted_cash": 5393.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1435.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 481.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1100.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 369.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10088.0, "maximum": 38439.68, "estimated_discounted_cash": 117870.97, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10088.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22663.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19590.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18924.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18190.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30441.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38439.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10088.0, "maximum": 22046.45, "estimated_discounted_cash": 81658.52, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10088.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12672.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11235.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10854.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10432.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MELATONIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307082", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MELOXICAM 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307095", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MELOXICAM 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307095", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MELPHALAN ORAL 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8600", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.52, "maximum": 45.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMANTINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMANTINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307111", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 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"billing_class": "facility"}]}, {"description": "MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [{"code": "Q4126", "type": "HCPCS"}], "standard_charges": [{"minimum": 297.15, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 297.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 476.86, "maximum": 476.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL B OMV VAC PFSIJ", "code_information": [{"code": "90620", "type": "CPT"}, {"code": "5322056", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 782.61, "maximum": 782.61, "gross_charge": 912.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 782.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL B OMV VAC PFSIJ", "code_information": [{"code": "90620", "type": "CPT"}, {"code": "5322056", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 782.61, "maximum": 782.61, "gross_charge": 912.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 782.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL VAC IM IJ", "code_information": [{"code": "90734", "type": "CPT"}, {"code": "5322059", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 622.92, "maximum": 622.92, "gross_charge": 895.0, "discounted_cash": 671.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 622.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENINGOCOCCAL VAC IM IJ", "code_information": [{"code": "90734", "type": "CPT"}, {"code": "5322059", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 622.92, "maximum": 622.92, "gross_charge": 895.0, "discounted_cash": 671.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 622.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS 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2041.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENS SHOES HIGHTOP DEPTH INL", "code_information": [{"code": "L3222", "type": "HCPCS"}], "standard_charges": [{"minimum": 348.77, "maximum": 348.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 348.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10934.4, "maximum": 23106.01, "estimated_discounted_cash": 64254.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12236.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11775.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11375.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10934.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18298.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23106.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6191.64, "maximum": 13083.85, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 7267.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6668.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6441.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6191.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10361.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13083.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE 25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5327650", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2175", "type": "HCPCS"}, {"code": "5327637", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 27.69, "maximum": 27.69, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2175", "type": "HCPCS"}, {"code": "5327637", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 27.69, "maximum": 27.69, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE/PROMETHAZINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2180", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.66, "maximum": 37.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAIN 1% PER10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322101", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAIN 1% PER10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322101", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAIN 2% PER10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322100", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAIN 2% PER10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322100", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAINE1.5%PER10MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322099", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAINE1.5%PER10MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "5322099", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 12.48, "maximum": 12.48, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50 MG", "code_information": [{"code": "S0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.67, "maximum": 9.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5307276", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCAPTOPURINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5307276", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCURY QUANTITATIVE", "code_information": [{"code": "83825", "type": "CPT"}, {"code": "7253825", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.67, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERCURY QUANTITATIVE/2", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROHEMATOCRIT SPUN", "code_information": [{"code": "85013", "type": "CPT"}, {"code": "4125054", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.55, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 313.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSAT INSTABILITY ANL", "code_information": [{"code": "81301", "type": "CPT"}, {"code": "7251302", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1322.09, "gross_charge": 1402.0, "discounted_cash": 1051.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 563.14, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER 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PPO", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSURG EPI SPERM ASP", "code_information": [{"code": "S4028", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROSURGERY ADD-ON", "code_information": [{"code": "69990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 779.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIDAZOLAM 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327730", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDAZOLAM 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327730", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDAZOLAM 2MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 305.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 540.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 181.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 513.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ ANES SHO JT FIXJ APRATS", "code_information": [{"code": "23700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 722.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 243.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ ELBOW UNDER ANES", "code_information": [{"code": "24300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1646.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 555.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 877.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 496.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1172.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 918.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MNTR IO PRESS 24HRS/> UNI/BI", "code_information": [{"code": "329T", "type": "CPT"}], "standard_charges": [{"minimum": 3838.74, "maximum": 3838.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3838.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 430.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 144.24, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MOBILIZE ERUPTED/MALPOS TOOT", "code_information": [{"code": "D7282", "type": "HCPCS"}], "standard_charges": [{"minimum": 813.14, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 813.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED GI >5YRS INIT15", "code_information": [{"code": "G0500", "type": "HCPCS"}, {"code": "5079158", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 729.0, "discounted_cash": 546.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH EA ADD15", "code_information": [{"code": "99157", "type": "CPT"}, {"code": "3609157", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 472.0, "discounted_cash": 354.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH EA ADD15", "code_information": [{"code": "99157", "type": "CPT"}, {"code": "5079157", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH EA ADD15", "code_information": [{"code": "99157", "type": "CPT"}, {"code": "6109157", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH<5YRS INIT15", "code_information": [{"code": "99155", "type": "CPT"}, {"code": "3609155", "type": "CDM"}, {"code": "370", "type": 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"setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 72.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME<5YRS INIT15", "code_information": [{"code": "99151", "type": "CPT"}, {"code": "6109151", 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODAFINIL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307883", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODAFINIL 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5307883", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODIFICATION OF CONTACT LENS", "code_information": [{"code": "92325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 148.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODIFY SPEECH AID PROSTHESIS", "code_information": [{"code": "D5960", "type": "HCPCS"}], "standard_charges": [{"minimum": 832.6, "maximum": 832.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 5.15, "maximum": 143.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1283.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 346.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 827.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 346.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1151.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 341.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 777.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 341.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 683.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 237.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 499.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 237.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 633.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 233.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 478.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 233.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 180.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLD CEMENT SPACER HIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4014149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 458.0, "discounted_cash": 343.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 100-300", "code_information": [{"code": "88275", "type": "CPT"}, {"code": "7048827", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.16, "gross_charge": 661.0, "discounted_cash": 495.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 90.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 42.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 100-300", "code_information": [{"code": "88275", "type": "CPT"}, {"code": "7070050", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.16, "gross_charge": 661.0, "discounted_cash": 495.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 90.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 42.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 100-300", "code_information": [{"code": "88275", "type": "CPT"}, {"code": "7258201", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.16, "gross_charge": 719.0, "discounted_cash": 539.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 77.99, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 90.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 42.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 46.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTOGEN INTPHS 25-99", "code_information": [{"code": "88274", "type": "CPT"}, {"code": "7048274", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 160.75, "gross_charge": 686.0, "discounted_cash": 514.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 67.6, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 78.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 38.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 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{"code": "4024083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5936.0, "discounted_cash": 4452.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH H VENTRALIGHT ST", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8516.0, "discounted_cash": 6387.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH LAPAROSCOPIC SLF-FIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5750.0, "discounted_cash": 4312.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH POLYPRO PLUG EXL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3079.0, "discounted_cash": 2309.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH POLYPRO PLUG LG", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3292.0, "discounted_cash": 2469.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH POLYPRO PLUG M", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2565.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH POLYPRO PLUG S", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2594.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8175345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9345.0, "discounted_cash": 7008.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH REMODELING ADJ COMANECI", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8175339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44400.0, "discounted_cash": 33300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH RESORB FULL SCAFFOLD", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11490.0, "discounted_cash": 8617.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH RESTORELLE Y", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10461.0, "discounted_cash": 7845.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH VENTRALEX W STRP", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4884.0, "discounted_cash": 3663.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH VENTRALIGHT POS SYS", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28344.0, "discounted_cash": 21258.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MSH2 DUP/DEL VARIANTS", "code_information": [{"code": "81297", "type": "CPT"}, {"code": "7251298", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 809.05, "gross_charge": 716.0, "discounted_cash": 537.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 216.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 88.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 98.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 809.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 FULL SEQUENCE VAR", "code_information": [{"code": "81295", "type": "CPT"}, {"code": "7251296", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1447.79, "gross_charge": 1367.0, "discounted_cash": 1025.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 216.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 88.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 98.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1447.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 343.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 343.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 343.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 343.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 343.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE KNOWN VARIANTS", "code_information": [{"code": "81296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1281.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 184.68, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 214.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 75.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 84.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1281.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 303.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 303.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 303.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 303.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 303.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH2 MRNA SEQ ALYS", "code_information": [{"code": "159U", "type": "CPT"}], "standard_charges": [{"minimum": 192.7, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 192.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 214.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 DUP/DEL VARIANTS", "code_information": [{"code": "81300", "type": "CPT"}, {"code": "7251301", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 902.73, "gross_charge": 762.0, "discounted_cash": 571.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 230.49, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 267.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 94.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 105.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 902.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 FULL SEQUENCE VAR", "code_information": [{"code": "81298", "type": "CPT"}, {"code": "7251299", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2434.54, "gross_charge": 1439.0, "discounted_cash": 1079.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 410.33, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 476.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 187.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2434.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE KNOWN VARIANTS", "code_information": [{"code": "81299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1168.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 229.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 266.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 94.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 105.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1168.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MSH6 MRNA SEQ ALYS", "code_information": [{"code": "160U", "type": "CPT"}], "standard_charges": [{"minimum": 192.7, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 192.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 214.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MT BONE GRAFT MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9971.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3345.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTB AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}, {"code": "7047556", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 158.09, "gross_charge": 1336.0, "discounted_cash": 1002.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 158.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTB AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}, {"code": "7257556", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 158.09, "gross_charge": 1070.0, "discounted_cash": 802.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 158.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTHFR COMMON VARIANTS", "code_information": [{"code": "81291", "type": "CPT"}, {"code": "7259210", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 247.83, "gross_charge": 509.0, "discounted_cash": 381.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 84.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 247.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM ADDL 15 MIN", "code_information": [{"code": "99607", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM EST 15 MIN", "code_information": [{"code": "99606", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MTMS BY PHARM NP 15 MIN", "code_information": [{"code": "99605", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MUCOPOLYSACCHARIDES", "code_information": [{"code": "83864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCORMYCOSIS ANTIBODY", "code_information": [{"code": "86732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULT FAM ADAPT BHV TX GDN", "code_information": [{"code": "97157", "type": "CPT"}], "standard_charges": [{"minimum": 125.17, "maximum": 125.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULT SLEEP LATENCY TEST", "code_information": [{"code": "95805", "type": "CPT"}, {"code": "6912115", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1693.0, "gross_charge": 13997.0, "discounted_cash": 10497.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1475.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1364.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1693.0, "methodology": "per diem"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTI ORGANISMS AMP PRB", "code_information": [{"code": "87801", "type": "CPT"}, {"code": "7040094", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 266.27, "gross_charge": 1124.0, "discounted_cash": 843.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 136.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 158.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 73.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 81.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTI ORGANISMS AMP PRB", "code_information": [{"code": "87801", "type": "CPT"}, {"code": "7257826", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 266.27, "gross_charge": 3997.0, "discounted_cash": 2997.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 136.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 158.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 73.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 81.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"billing_class": "facility"}]}, {"description": "MUPIROCIN 2% 22GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331488", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUPIROCIN 2% 22GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331488", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}, {"code": "7255546", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 71.12, "gross_charge": 209.0, "discounted_cash": 156.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36.43, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 42.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSC MYOQ/FSCQ FLP H&N PEDCL", "code_information": [{"code": "15733", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 31796.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3745.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1255.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC/TDN TRANSFER UPR A/E 1", "code_information": [{"code": "24301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2764.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 928.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE BIOPSY SUPERFICIAL", "code_information": [{"code": "20200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 345.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 258.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERV UNILAT", "code_information": [{"code": "95867", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 238.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 75.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NERVE BILAT", "code_information": [{"code": "95868", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 280.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 219.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 219.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST LARYNX", "code_information": [{"code": "95865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 246.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 246.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST NONPARASPINAL", "code_information": [{"code": "95870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 231.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 231.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 73.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 153.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 45.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST THOR PARASPINAL", "code_information": [{"code": "95869", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 274.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER SHOULDER/ARM", "code_information": [{"code": "23395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4695.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1577.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFERS", "code_information": [{"code": "23397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4171.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT ARM", "code_information": [{"code": "15736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4431.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1485.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT LEG", "code_information": [{"code": "15738", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4604.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1539.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT TRUNK", "code_information": [{"code": "15734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5447.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1827.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 12.54, "maximum": 69.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MVI 10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5322591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 360.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MVI 15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315811", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI 15ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315811", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI 5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315807", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI 5ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5315807", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI DROPS 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316646", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI DROPS 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316646", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI FE CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307926", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI FE CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307926", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI MIN TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307943", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI MIN TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307943", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI MIN THERAP TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307916", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI MIN THERAP TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307916", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI PRENAT W/FA 1MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301910", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI PRENAT W/FA 1MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5301910", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI PRENATAL FA DOCUS TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312433", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI PRENATAL FA DOCUS TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI THERAP TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307912", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI THERAP TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5307912", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI VIT B COMPLEX FA TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312358", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MVI VIT B COMPLEX FA TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312358", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGPHY 2/> SPINE REGIONS", "code_information": [{"code": "72270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 729.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 407.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 98.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 656.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 729.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAM C/T/L LUMB INJ", "code_information": [{"code": "4902305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5285.0, "discounted_cash": 3963.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MYELOGRAM C/T/L LUMB INJ", "code_information": [{"code": "4912305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2024.0, "discounted_cash": 1518.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MYELOGRAPHY L-S SPINE", "code_information": [{"code": "72265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 715.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 374.43, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 426.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 474.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 715.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 302.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 307.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 423.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 300.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4114.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 439.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 328.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY NECK SPINE", "code_information": [{"code": "72240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 715.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 407.94, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 85.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 446.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 496.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.26, 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "4103873", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.01, "gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "4173873", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.01, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "7253873", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.01, "gross_charge": 251.0, "discounted_cash": 188.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN/2", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "7253875", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 49.01, "gross_charge": 185.0, "discounted_cash": 138.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.08, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 49.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4219.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1403.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3372.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1121.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAG METHOD", "code_information": [{"code": "58145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2090.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 685.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOWN HARV PREP PROC SQ CM", "code_information": [{"code": "Q4226", "type": "HCPCS"}], "standard_charges": [{"minimum": 1465.96, "maximum": 1465.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1465.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 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paid as: other.", "standard_charge_dollar": 697.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 774.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Lower Extremities", "code_information": [{"code": "616", "type": "RC"}], "standard_charges": [{"minimum": 697.0, "maximum": 774.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 697.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 774.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology 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"methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 774.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Spinal Cord/Spine", "code_information": [{"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 697.0, "maximum": 774.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 697.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 774.0, "methodology": "other"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology, Other Magnetic Resonance Imaging (MRI)", 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{"description": "Measurement Of 80 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "146U", "type": "CPT"}], "standard_charges": [{"minimum": 434.03, "maximum": 434.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of 85 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "147U", "type": "CPT"}], "standard_charges": [{"minimum": 434.03, "maximum": 434.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Diameters Of Pelvis In Female", "code_information": [{"code": "74710", "type": "CPT"}], "standard_charges": [{"minimum": 36.7, "maximum": 88.98, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Exhaled Carbon Dioxide Gas", "code_information": [{"code": "94770", "type": "CPT"}], "standard_charges": [{"minimum": 28.26, "maximum": 28.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Measurement Of Lung Stretching Capacity", "code_information": [{"code": "94750", "type": "CPT"}], "standard_charges": [{"minimum": 285.31, "maximum": 285.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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use with k1016", "code_information": [{"code": "K1017", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.0, "maximum": 143.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Mycobacterium tuberculosis, culture filtrate protein-10-kDa (CFP-10), serum or plasma, liquid chromatography mass spectrometry (LC-MS)", "code_information": [{"code": "574U", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ CELIAC PELUS", "code_information": [{"code": "64530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 344.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS 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"methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ HYPOGAS PLXS", "code_information": [{"code": "64517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 459.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK LUMBAR/THORACIC", "code_information": [{"code": "64520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 273.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK SPENOPALATINE GANGL", "code_information": [{"code": "64505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 176.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK STELLATE GANGLION", "code_information": [{"code": "64510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 174.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", 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"5334811", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NA HYPOCHL.125% 480ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NA HYPOCHLOR 0.0625% 480ML TS", "drug_information": {"unit": 1.0, "type": "EA"}, 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"plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOP PO DEBRID", "code_information": [{"code": "S2342", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY DX", "code_information": [{"code": "31231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 234.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL PROSTHESIS", "code_information": [{"code": "D5913", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 10411.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10411.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SEPTAL PROSTHESIS", "code_information": [{"code": "D5922", "type": "HCPCS"}], "standard_charges": [{"minimum": 6766.71, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6766.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL SINUS THERAPY", "code_information": [{"code": "30210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 379.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 183.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SMEAR FOR EOSINOPHILS", "code_information": [{"code": "89190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL VACCINE INHALATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3530", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 729.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 848.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4161.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1394.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4453.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1489.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY", "code_information": [{"code": "92511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 138.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 83.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 83.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASOTRACH CATH SUCTION", "code_information": [{"code": "5501720", "type": "CDM"}, {"code": "419", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NAT KILLER CELL TOT CNT", "code_information": [{"code": "86357", "type": "CPT"}, {"code": "7250018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 143.11, "gross_charge": 319.0, "discounted_cash": 239.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 73.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 85.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2323", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.75, "maximum": 92.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATEGLINIDE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308092", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATEGLINIDE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308092", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP 60 MIN PR M", "code_information": [{"code": "G0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 182.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAV SRV PEER SUP ADD 30 PR M", "code_information": [{"code": "G0146", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 61.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 344.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1010.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1221.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1010.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 515.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NC CONVALESCENT FFP", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "4500075", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"minimum": 303.29, "maximum": 303.29, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NC CONVALESCENT PATH REDCD FFP", "code_information": [{"code": "P9071", "type": "HCPCS"}, {"code": "4500076", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "NC CONVALESCNT CRYORDCD FFP", "code_information": [{"code": "P9044", "type": "HCPCS"}, {"code": "4500078", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"minimum": 262.29, "maximum": 262.29, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 262.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NC CONVALESCNT FRSH LIQ PLASMA", "code_information": [{"code": "P9099", "type": "HCPCS"}, {"code": "4500077", "type": "CDM"}, {"code": "399", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD 1", "code_information": [{"code": "640T", "type": "CPT"}], "standard_charges": [{"minimum": 12.37, "maximum": 12.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC O/T PAD EA", "code_information": [{"code": "859T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC IFR SPCTRSC SCR PAD", "code_information": [{"code": "860T", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG 1ST", "code_information": [{"code": "598T", "type": "CPT"}], "standard_charges": [{"minimum": 28.45, "maximum": 264.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 264.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NCNTC R-T FLUOR WND IMG EA", "code_information": [{"code": "599T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDL BX BN MAR PWR", "code_information": [{"code": "C1830", "type": "HCPCS"}, {"code": "8183307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3813.0, "discounted_cash": 2859.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NDL CENTESIS YUEH", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8178171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.0, "discounted_cash": 185.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 45.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 153.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC DCMPRN 1 NTRSPC LUMBAR", "code_information": [{"code": "62380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4834.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 610.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"minimum": 82.04, "maximum": 82.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308102", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308103", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308103", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308106", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308106", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308104", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEBIVOLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308104", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NECK FOR SOFT TISSUES", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "4900360", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.01, "gross_charge": 1372.0, "discounted_cash": 1029.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 45.32, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4017.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1352.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4935.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1654.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 869.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 293.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 300.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 205.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER ADD-ON", "code_information": [{"code": "47001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 370.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 124.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH NODES", "code_information": [{"code": "38505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3961.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 308.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 208.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY OF LIVER", "code_information": [{"code": "47000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4496.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 315.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 355.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 221.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY PANCREAS", "code_information": [{"code": "48102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 844.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 288.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 605.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 288.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINAL CORD", "code_information": [{"code": "62269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 935.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 315.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE ELCTRMYGPH NONEXT", "code_information": [{"code": "95887", "type": "CPT"}, {"code": "4805887", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 169.55, "gross_charge": 427.0, "discounted_cash": 320.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 169.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE ELCTROMEYGPHY CMP", "code_information": [{"code": "95886", "type": "CPT"}, {"code": "4805886", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 188.89, "gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 188.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE ELCTROMYGRPHY LTD", "code_information": [{"code": "95885", "type": "CPT"}, {"code": "4805884", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 158.62, "gross_charge": 700.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 158.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEFAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308095", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEFAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308095", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEFAZODONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308096", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEFAZODONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308096", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS THRPY <=50CM", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "6907608", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.76, "gross_charge": 896.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 52.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS THRPY >50CM", "code_information": [{"code": "97606", "type": "CPT"}, {"code": "6907609", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 97.37, "gross_charge": 1247.0, "discounted_cash": 935.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 63.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS TX MPD <50CM", "code_information": [{"code": "97607", "type": "CPT"}, {"code": "6900456", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1265.8, "gross_charge": 1584.0, "discounted_cash": 1188.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS TX MPD >50CM", "code_information": [{"code": "97608", "type": "CPT"}, {"code": "6900457", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1309.12, "gross_charge": 1805.0, "discounted_cash": 1353.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1309.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NELARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9261", "type": "HCPCS"}], "standard_charges": [{"minimum": 420.95, "maximum": 420.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEO/BAC/POLY/HC 15GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337081", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEO/BAC/POLY/HC 15GM OI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337081", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 564.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEO/BAC/POLYB 30GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336775", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/BAC/POLYB 30GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336775", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/BAC/POLYB.9GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336777", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/BAC/POLYB.9GM OI", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336777", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMY/POLY/BACIT3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331612", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY/BACIT3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331612", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY/GRAMICD10MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331605", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY/GRAMICD10MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331605", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY/HCTS 7.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331566", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMY/POLY/HCTS 7.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331566", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 399.0, "discounted_cash": 299.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308105", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMYCIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308105", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMB IR 1MLTS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336779", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 222.0, "discounted_cash": 166.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATAL EMERGENCY TRANSPORT", "code_information": [{"code": "A0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 1310.22, "maximum": 1310.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1310.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3244.95, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3244.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1076.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE SUBSQ", "code_information": [{"code": "99469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1403.22, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1403.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 465.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 18547.79, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18547.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1840.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1825.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1754.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2860.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3611.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 22650.42, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22650.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1840.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1825.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1754.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2860.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3611.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEOPATCH OR THERION, 1 SQ CM", "code_information": [{"code": "Q4176", "type": "HCPCS"}], "standard_charges": [{"minimum": 250.03, "maximum": 250.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIGMINE UPTO .5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2710", "type": "HCPCS"}, {"code": "5322810", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.66, "maximum": 2.66, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIGMINE UPTO .5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2710", "type": "HCPCS"}, {"code": "5322810", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.66, "maximum": 2.66, "gross_charge": 14.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIM DL PER SQ CM", "code_information": [{"code": "Q4267", "type": "HCPCS"}], "standard_charges": [{"minimum": 3316.98, "maximum": 3316.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3316.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIM PER SQ CM", "code_information": [{"code": "Q4266", "type": "HCPCS"}], "standard_charges": [{"minimum": 2576.02, "maximum": 2576.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2576.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIM TL PER SQ CM", "code_information": [{"code": "Q4265", "type": "HCPCS"}], "standard_charges": [{"minimum": 2885.52, "maximum": 2885.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2885.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOX 100 OR CLARIX 100", "code_information": [{"code": "Q4156", "type": "HCPCS"}], "standard_charges": [{"minimum": 580.33, "maximum": 580.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOX NEOX RT OR CLARIX CORD", "code_information": [{"code": "Q4148", "type": "HCPCS"}], "standard_charges": [{"minimum": 870.49, "maximum": 870.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD ALG RSK DBTC KDN DS", "code_information": [{"code": "385U", "type": "CPT"}], "standard_charges": [{"minimum": 266.18, "maximum": 1482.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 266.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 295.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1482.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"minimum": 855.0, "maximum": 3603.35, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 860.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 956.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3603.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"minimum": 36.27, "maximum": 199.93, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH CKD RSK HI STG KDN DS", "code_information": [{"code": "384U", "type": "CPT"}], "standard_charges": [{"minimum": 510.91, "maximum": 2844.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 510.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PRETRNSPL PERPH BLD", "code_information": [{"code": "319U", "type": "CPT"}], "standard_charges": [{"minimum": 1805.22, "maximum": 10051.45, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1805.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2005.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10051.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPH RNA PSTTRNSPL PERPH BLD", "code_information": [{"code": "320U", "type": "CPT"}], "standard_charges": [{"minimum": 1805.22, "maximum": 10051.45, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1805.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2005.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10051.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHELOMETRY EA ANALYTE", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "7253949", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.58, "gross_charge": 661.0, "discounted_cash": 495.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHELOMETRY EA ANALYTE", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "7258427", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.58, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3386.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1136.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NERV COND STUDIES 3-4", "code_information": [{"code": "95908", "type": "CPT"}, {"code": "4805908", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 170.61, "gross_charge": 750.0, "discounted_cash": 562.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 55.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 1-2", "code_information": [{"code": "95907", "type": "CPT"}, {"code": "4805907", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 139.13, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 139.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 11-12", "code_information": [{"code": "95912", "type": "CPT"}, {"code": "4805912", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 337.54, "gross_charge": 2249.0, "discounted_cash": 1686.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 5-6", "code_information": [{"code": "95909", "type": "CPT"}, {"code": "4805909", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 205.69, "gross_charge": 1124.0, "discounted_cash": 843.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 205.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 7-8", "code_information": [{"code": "95910", "type": "CPT"}, {"code": "4805910", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 261.41, "gross_charge": 1501.0, "discounted_cash": 1125.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE COND STUDIES 9-10", "code_information": [{"code": "95911", "type": "CPT"}, {"code": "4805911", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 298.96, "gross_charge": 1874.0, "discounted_cash": 1405.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 298.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 95.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2128.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2463.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 826.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK <4 CM", "code_information": [{"code": "64885", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3921.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1310.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4690.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1569.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL GRAFT", "code_information": [{"code": "15840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3690.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1230.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9774.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9774.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3283.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6461.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2172.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3648.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1215.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4722.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4722.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1585.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE REPAIR W/ALLOGRAFT", "code_information": [{"code": "64910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2788.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 935.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 886.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 297.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE TEASING PREPARATIONS", "code_information": [{"code": "88362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 590.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 213.34, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 303.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 114.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 441.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16571.45, "maximum": 35017.92, "estimated_discounted_cash": 183499.24, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19009.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17846.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17240.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16571.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27731.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35017.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11065.72, "maximum": 23383.51, "estimated_discounted_cash": 255503.77, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14847.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11917.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11512.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11065.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18517.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23383.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NESIRITIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2325", "type": "HCPCS"}], "standard_charges": [{"minimum": 273.02, "maximum": 273.02, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"minimum": 368.52, "maximum": 2051.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 368.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 409.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2051.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"minimum": 135.38, "maximum": 753.82, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 135.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 150.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 753.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT", "code_information": [{"code": "28055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1434.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 482.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2091.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 702.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1938.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURFLMNT LT CHN DIG IA QUAN", "code_information": [{"code": "361U", "type": "CPT"}], "standard_charges": [{"minimum": 104.61, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 104.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 104.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 104.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 104.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALYS B-AMYL 1-42&1-40", "code_information": [{"code": "358U", "type": "CPT"}], "standard_charges": [{"minimum": 177.46, "maximum": 988.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 177.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 197.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"minimum": 1509.17, "maximum": 8403.01, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1509.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1676.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8403.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1993.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 522.9, "maximum": 2882.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 522.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 581.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2882.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 348.23, "maximum": 1938.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 386.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1938.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 460.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 14 ACYL CARN", "code_information": [{"code": "322U", "type": "CPT"}], "standard_charges": [{"minimum": 516.03, "maximum": 2844.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 516.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 573.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 516.03, "maximum": 2844.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 516.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 573.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"minimum": 1207.49, "maximum": 7396.35, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1207.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1341.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7396.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"minimum": 516.03, "maximum": 2844.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 516.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 573.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "410U", "type": "CPT"}], "standard_charges": [{"minimum": 790.22, "maximum": 4399.88, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 790.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 878.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4399.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CERE FOLATE DEFNCY SRM", "code_information": [{"code": "412U", "type": "CPT"}], "standard_charges": [{"minimum": 675.0, "maximum": 675.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 486.89, "maximum": 2051.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 490.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 544.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2051.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 486.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 1057.51, "maximum": 5829.92, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1057.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1175.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5829.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1383.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 1512.53, "maximum": 8338.34, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1512.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1680.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8338.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1978.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 1568.01, "maximum": 8644.25, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1568.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1742.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8644.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2051.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 109.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 226.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8667.21, "maximum": 18315.09, "estimated_discounted_cash": 56984.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9807.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9334.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9016.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8667.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14504.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18315.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR JNCTN TEST", "code_information": [{"code": "95937", "type": "CPT"}, {"code": "4805937", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 255.34, "gross_charge": 1037.0, "discounted_cash": 777.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 255.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 123.69, "estimated_discounted_cash": 648.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3733.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1253.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1827.0, "maximum": 24626.53, "estimated_discounted_cash": 86879.75, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1827.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12550.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12124.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11653.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19502.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24626.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP", "code_information": [{"code": "15750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3404.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1141.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUTRALIZATION TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 28.7, "maximum": 159.8, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 94.84, "maximum": 384.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 94.84, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 1164.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 1MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315804", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 1MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315804", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEVIRAPINE 10MG/ML 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315842", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee 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"standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, 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"standard_charge_dollar": 2749.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"minimum": 97.16, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 97.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 107.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128.37, "methodology": "fee 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"standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 107.85, "maximum": 594.55, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 107.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 594.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 137.61, "maximum": 758.6, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 137.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 152.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 758.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 5.55, "maximum": 30.65, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 177.46, "maximum": 988.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 177.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 197.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 988.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 234.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 98.14, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 98.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 109.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS AMP PRB", "code_information": [{"code": "352U", "type": "CPT"}], "standard_charges": [{"minimum": 541.0, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 180.94, "maximum": 997.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 180.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 201.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 997.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 236.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}, {"code": "7251596", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 64.97, "maximum": 273.82, "gross_charge": 719.0, "discounted_cash": 539.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 65.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 72.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 1448.41, "maximum": 8064.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1448.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1609.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8064.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1913.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"minimum": 283.92, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 283.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 315.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 374.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 374.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 374.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 374.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 374.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"minimum": 107.85, "maximum": 594.55, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 107.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 594.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 141.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS GU PTHGN ARG DETCJ", "code_information": [{"code": "372U", "type": "CPT"}], "standard_charges": [{"minimum": 283.92, "maximum": 1580.85, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 283.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 315.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 384.53, "maximum": 1620.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 387.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 430.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1620.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 3 TRGT", "code_information": [{"code": "240U", "type": "CPT"}], "standard_charges": [{"minimum": 541.0, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 4 TRGT", "code_information": [{"code": "241U", "type": "CPT"}], "standard_charges": [{"minimum": 541.0, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3362.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1127.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIACIN 100MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308197", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 100MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308197", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 250MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308222", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 250MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308222", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 500MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308247", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 500MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308247", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 500MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308248", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 500MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308248", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 750MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308249", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIACIN 750MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308249", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NICARDIPINE 20MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308271", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE 20MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308271", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308272", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308272", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}, {"code": "5322851", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.23, "discounted_cash": 0.17, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}, {"code": "5322851", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.23, "discounted_cash": 0.17, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE PER 0.1MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}, {"code": "5322852", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.88, "discounted_cash": 0.66, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICARDIPINE PER 0.1MG PMX IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}, {"code": "5322852", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "gross_charge": 0.88, "discounted_cash": 0.66, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICOTINE 14MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336811", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE 14MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336811", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 63.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE 21MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336812", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE 21MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336812", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE 7MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336810", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE 7MG TD", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336810", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE GUM 2MG EA", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308275", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NICOTINE GUM 2MG EA", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308275", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NIFEDIPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308312", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308312", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 30MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308310", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308309", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 60MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308309", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 90MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308308", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIFEDIPINE 90MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308308", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11432.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11432.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3817.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12353.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12353.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4125.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NILOTINIB 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5308315", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NILOTINIB 150MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5308315", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 880.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315847", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315847", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308320", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308320", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 124.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315802", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 30MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315802", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 60MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315775", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 651.0, "discounted_cash": 488.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIMODIPINE 60MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315775", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 651.0, "discounted_cash": 488.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION", "code_information": [{"code": "19110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1292.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIRMATR-RITON 150/100 DOSE 2TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308348", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 584.0, "discounted_cash": 438.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336888", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NITROPRUSSIDE 50MG/2MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5322926", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NIVESTYM", "code_information": [{"code": "Q5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.1, "maximum": 1.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD AX NERVE IMG", "code_information": [{"code": "64417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 19303.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 101.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 101.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PL NFS IMG", "code_information": [{"code": "64416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PLXS IMG", "code_information": [{"code": "64415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 25131.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 68.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 68.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEM NRV NFS IMG", "code_information": [{"code": "64448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEMORAL NRV IMG", "code_information": [{"code": "64447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 19568.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 228.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GNCLR NRV BRNCH", "code_information": [{"code": "64454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10822.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 299.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 264.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GR OCPL NRV", "code_information": [{"code": "64405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD II IH NERVES", "code_information": [{"code": "64425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 18695.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 197.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD LMBR PLEX NFS", "code_information": [{"code": "64449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRVTG SI JT", "code_information": [{"code": "64451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 296.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV 1", "code_information": [{"code": "64420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 14813.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 211.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 119.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NTRCOST NRV EA", "code_information": [{"code": "64421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD OTHER PN/BRANCH", "code_information": [{"code": "64450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 12492.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PLTR COM DG NRV", "code_information": [{"code": "64455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PUDENDAL NERVE", "code_information": [{"code": "64430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SC NRV NFS IMG", "code_information": [{"code": "64446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SCIATIC NRV IMG", "code_information": [{"code": "64445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15321.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 189.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SPRSCAP NRV", "code_information": [{"code": "64418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 12823.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T 1", "code_information": [{"code": "64479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI C/T EA", "code_information": [{"code": "64480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 77.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 77.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S 1", "code_information": [{"code": "64483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 405.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 295.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TFRM EPI L/S EA", "code_information": [{"code": "64484", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 63.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD TRIGEMINAL NRV", "code_information": [{"code": "64400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1784.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 135.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1015.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX B1 SUB MTRL SBCHDRL DFCT", "code_information": [{"code": "707T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1346.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV LV/LA ANG", "code_information": [{"code": "93565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P ANGRPH MAPCA", "code_information": [{"code": "93575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 333.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT P-ART ANGRP BI", "code_information": [{"code": "93573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 225.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CATH SLCT PULM VN ANGRPH", "code_information": [{"code": "93574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 183.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2128.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 711.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 208.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CTH SLCT P-ART ANGRP UNI", "code_information": [{"code": "93569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 44.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 362.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 163.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 314.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 163.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 166.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 401.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 294.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 288.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 361.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 308.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 166.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 423.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1475.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 539.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1549.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 438.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 369.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 217.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PLATELET PLASMA", "code_information": [{"code": "232T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 277.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY CRV/THRC", "code_information": [{"code": "62291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 516.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX DISCOGRAPHY LUMBAR", "code_information": [{"code": "62290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 565.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 549.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 496.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 739.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 496.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 237.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 264.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 374.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 264.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 272.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 139.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX STM CL PRDCT ANL SFT TIS", "code_information": [{"code": "748T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 652.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4291.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1439.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4129.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1383.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5271.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5271.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1766.71, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4374.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1466.58, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NMES DISPOSABLE", "code_information": [{"code": "A4560", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.53, "maximum": 74.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOC RETAIL ITEMS ANDSUPPLIES", "code_information": [{"code": "T1999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 60.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON CORING NEEDLE OR STYLET", "code_information": [{"code": "A4212", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.6, "maximum": 20.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-AUTO GRAFT 1ST TOOTH", "code_information": [{"code": "D4275", "type": "HCPCS"}], "standard_charges": [{"minimum": 1162.86, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1162.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [{"code": "98", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24906.55, "maximum": 52631.24, "estimated_discounted_cash": 201027.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25042.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26822.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25911.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24906.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41679.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52631.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [{"code": "97", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39198.87, "maximum": 82833.02, "estimated_discounted_cash": 352391.38, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46074.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42214.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40780.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39198.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65597.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82833.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "99", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14786.13, "maximum": 31245.28, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16913.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15923.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15382.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14786.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24743.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31245.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-COV PROC, CLINICAL TRIAL", "code_information": [{"code": "G0294", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"NON-EMER TRANSPORT WAIT TIME", "code_information": [{"code": "T2007", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21441.2, "maximum": 47244.04, "estimated_discounted_cash": 26933.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 42.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA 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PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "988", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17837.99, "maximum": 37694.32, "estimated_discounted_cash": 114209.44, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25704.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19210.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18557.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17837.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29851.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37694.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE O.R. 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rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27502.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 234.74, "maximum": 870.8, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 359.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 234.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 260.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 870.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-INHALATION DRUG FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7799", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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"CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 881.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3201.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE UNI", "code_information": [{"code": "69705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 631.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3091.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRAS VARIANT EXON 2-3", "code_information": [{"code": "81311", "type": "CPT"}, {"code": "7251311", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1121.93, "gross_charge": 2912.0, "discounted_cash": 2184.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 422.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 300.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 333.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1121.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 266.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC GEN SEQ VRNT ALY 13", "code_information": [{"code": "419U", "type": "CPT"}], "standard_charges": [{"minimum": 910.17, "maximum": 5067.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 910.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1011.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5067.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 386.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 386.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP EA", "code_information": [{"code": "96133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 279.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 118.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 13/> STUDIES", "code_information": [{"code": "95913", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 373.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG <4CM", "code_information": [{"code": "64892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3827.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1284.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG >4 CM", "code_information": [{"code": "64893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4079.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1369.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT <4CM", "code_information": [{"code": "64890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3931.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1319.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT >4CM", "code_information": [{"code": "64891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4180.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1403.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG <4 CM", "code_information": [{"code": "64897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4602.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1545.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG >4 CM", "code_information": [{"code": "64898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4984.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1674.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT <4 CM", "code_information": [{"code": "64895", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4812.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1616.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT >4 CM", "code_information": [{"code": "64896", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5191.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1743.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT 1ST", "code_information": [{"code": "64912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3267.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1093.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 621.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 206.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES B", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907605", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 311.14, "maximum": 311.14, "gross_charge": 1247.0, "discounted_cash": 935.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES B", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907605", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 311.14, "maximum": 311.14, "gross_charge": 1247.0, "discounted_cash": 935.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES I", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907606", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 311.14, "maximum": 311.14, "gross_charge": 858.0, "discounted_cash": 643.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSEL DEB WNDS WO ANES I", "code_information": [{"code": "97602", "type": "CPT"}, {"code": "6907606", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 311.14, "maximum": 311.14, "gross_charge": 858.0, "discounted_cash": 643.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 493.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 327.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 581.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 374.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC FRNT TISS RMVL", "code_information": [{"code": "31276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1370.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 457.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3917.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1303.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3607.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1204.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SPHN TISS RMVL", "code_information": [{"code": "31259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1706.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 571.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SRG NSL HEMRRG", "code_information": [{"code": "31238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 609.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 312.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG BX POLYPC", "code_information": [{"code": "31237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT SINS", "code_information": [{"code": "31296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 650.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1558.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1931.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1558.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT&SPHN", "code_information": [{"code": "31298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 928.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3565.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG MAX SINS", "code_information": [{"code": "31295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 572.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1554.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1899.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1554.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4472.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1489.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG SPHN SINS", "code_information": [{"code": "31297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 522.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1553.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1881.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1553.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1615.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 539.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1810.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 604.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/PRTL ETHMDCT", "code_information": [{"code": "31254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 882.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 530.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/TOT ETHMDCT", "code_information": [{"code": "31255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1171.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 391.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2214.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 741.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC CRYOABLTJ PNN", "code_information": [{"code": "31243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 573.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2798.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC RF ABLTJ PNN", "code_information": [{"code": "31242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 573.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2881.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC CNCH BULL RESCJ", "code_information": [{"code": "31240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 194.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1613.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 537.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 4", "code_information": [{"code": "Q1004", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 5", "code_information": [{"code": "Q1005", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 200.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 405.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}], "standard_charges": [{"minimum": 356.59, "maximum": 1965.84, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 356.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 396.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1965.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 786.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 158.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 786.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 786.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 158.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 786.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK3 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81193", "type": "CPT"}], "standard_charges": [{"minimum": 142.63, "maximum": 786.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 158.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 786.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 11-20", "code_information": [{"code": "99447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 131.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 131.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 21-30", "code_information": [{"code": "99448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 195.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 195.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 31/>", "code_information": [{"code": "99449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 260.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5-10", "code_information": [{"code": "99446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5/>", "code_information": [{"code": "99451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR RFRL", "code_information": [{"code": "99452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 123.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 42.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR CPLX", "code_information": [{"code": "77386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1292.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1292.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1287.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1287.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 243.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 243.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 92.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHYS/QHP 1ST HR", 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS ADD-ON", "code_information": [{"code": "76814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 154.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 50.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 138.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 154.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 32.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "413U", "type": "CPT"}], "standard_charges": [{"minimum": 860.73, "maximum": 4792.57, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 860.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 956.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4792.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1137.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB XPND CAR SCR 145 GENES", "code_information": [{"code": "414U", "type": "CPT"}], "standard_charges": [{"minimum": 481.1, "maximum": 2678.81, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 481.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 534.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2678.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 635.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBINUTUZUMAB INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9301", "type": "HCPCS"}], "standard_charges": [{"minimum": 266.81, "maximum": 266.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 201 ICC 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240410", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 205 CIC 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240510", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 212 IP HOLD 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6241820", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 215 DOU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240652", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 216 SDU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240656", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 218 SDU 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240664", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 230 M/S 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240612", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 232 M/S 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240616", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 243 PSY 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240683", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS 270 REH 1/HR", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "6240810", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.07, "gross_charge": 328.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 283.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 145.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 103.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 115.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 283.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 67.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8801.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8801.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2925.93, 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2893.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3917.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1304.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICS PROFILE", "code_information": [{"code": "80055", "type": "CPT"}, {"code": "4120215", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.34, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 48.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRICS PROFILE", "code_information": [{"code": "80055", "type": "CPT"}, {"code": "4150215", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.34, "gross_charge": 2614.0, "discounted_cash": 1960.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 92.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 48.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 43.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"code": "5331635", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PF 10ML GL", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331637", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PF 10ML GL", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331637", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PF.4ML UD OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332036", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PF.4ML UD OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332036", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PRSRV 15ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332130", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB PRSRV 15ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5332130", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB W/POVIDONE 15ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331631", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR LUB W/POVIDONE 15ML OS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331631", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 750.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 340.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS", "code_information": [{"code": "D5916", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 14576.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14576.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS INTERIM", "code_information": [{"code": "D5923", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 8328.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8328.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2146.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 715.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4797.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1598.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4144.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1381.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTICS ENDOSTEAL IMPLANT", "code_information": [{"code": "D6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 2772.27, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2772.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ODONTICS EPOSTEAL IMPLANT", "code_information": [{"code": "D6040", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 9995.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9995.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ODONTICS REPR ABUTMENT", "code_information": [{"code": "D6095", "type": "HCPCS"}], "standard_charges": [{"minimum": 1016.41, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1016.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ODONTICS TRANSOSTEAL IMPLNT", "code_information": [{"code": "D6050", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 7977.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7977.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ODONTOPLASTY PER TOOTH", "code_information": [{"code": "D9971", "type": "HCPCS"}], "standard_charges": [{"minimum": 183.54, "maximum": 183.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 183.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFATUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9302", "type": "HCPCS"}], "standard_charges": [{"minimum": 242.59, "maximum": 242.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 242.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX 70MIN", "code_information": [{"code": "G2086", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1469.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1469.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 572.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, 60 M", "code_information": [{"code": "G2087", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1417.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1417.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 518.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, ADD30", "code_information": [{"code": "G2088", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 139.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF/OP CNSLTJ NEW/EST LOW 30", "code_information": [{"code": "99243", "type": "CPT"}], "standard_charges": [{"minimum": 21.79, "maximum": 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[{"minimum": 3.79, "maximum": 3.79, "gross_charge": 113.0, "discounted_cash": 84.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2357", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.67, "maximum": 149.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMEGA3 FISH OIL 1000MGCP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308530", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OMEGA3 FISH OIL 1000MGCP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5308530", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OMENTAL FLAP EXTRA-ABDOM", "code_information": [{"code": "49904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5044.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1680.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP INTRA-ABDOM", "code_information": [{"code": "49905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 422.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308486", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 82.0, "discounted_cash": 61.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMEPRAZOLE 20MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308486", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 82.0, "discounted_cash": 61.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMEZA COLLAG PER 100 MG", "code_information": [{"code": "A2014", "type": "HCPCS"}], "standard_charges": [{"minimum": 208.27, "maximum": 208.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC AML DNA DETC/NONDETC", "code_information": [{"code": "23U", "type": "CPT"}, {"code": "7250044", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 223.66, "maximum": 942.6, "gross_charge": 2110.0, "discounted_cash": 1582.5, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 225.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 250.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 942.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 223.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 223.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 223.66, 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32240.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DLBCL MRNA 20 GENES ALG", "code_information": [{"code": "17M", "type": "CPT"}], "standard_charges": [{"minimum": 1727.1, "maximum": 9521.23, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1727.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1919.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9521.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2259.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2259.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2259.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2259.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2259.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST METASTIC/ RECUR", "code_information": [{"code": "G9075", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2 NOPROGRES", "code_information": [{"code": "G9072", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG1-2B HR,NOPRO", "code_information": [{"code": "G9071", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-HR, NO PRO", "code_information": [{"code": "G9073", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST STG3-NOPROGRESS", "code_information": [{"code": "G9074", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX BRST UNKNOWN NOS", "code_information": [{"code": "G9131", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML ACCELER PHASE", "code_information": [{"code": "G9124", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML BLAST PHASE", "code_information": [{"code": "G9125", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML CHRONIC PHASE", "code_information": [{"code": "G9123", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML DX STATUS UNKNOWN", "code_information": [{"code": "G9139", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX CML REMISSION", "code_information": [{"code": "G9126", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON EXTENT UNKNOWN", "code_information": [{"code": "G9089", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS EVID DX", "code_information": [{"code": "G9087", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON METAS NOEVID DX", "code_information": [{"code": "G9088", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-3,N1-2,NO PR", "code_information": [{"code": "G9084", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T1-4 NO DX PROG", "code_information": [{"code": "G9086", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX COLON T4, N0 W/O PROG", "code_information": [{"code": "G9085", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAG T1-T3 NOPROG", "code_information": [{"code": "G9096", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL METS RECUR", "code_information": [{"code": "G9098", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL T4 NO PROG", "code_information": [{"code": "G9097", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX ESOPHAGEAL UNKNOWN", "code_information": [{"code": "G9099", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC NO RECURRENCE", "code_information": [{"code": "G9100", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC P R1-R2NOPROG", "code_information": [{"code": "G9101", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC RECURRENT", "code_information": [{"code": "G9103", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNKNOWN NOS", "code_information": [{"code": "G9104", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX GASTRIC UNRESECTABLE", "code_information": [{"code": "G9102", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK EXT UNKNOWN", "code_information": [{"code": "G9112", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK M1 METS REC", "code_information": [{"code": "G9111", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T1-T2NO PRG", "code_information": [{"code": "G9109", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX HEAD/NECK T3-4 NOPROG", "code_information": [{"code": "G9110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULT MYELOMA STG2 HIG", "code_information": [{"code": "G9129", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA STAGE I", "code_information": [{"code": "G9128", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX MULTI MYELOMA UNKNOWN", "code_information": [{"code": "G9130", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL RELAPSE/REFRACTOR", "code_information": [{"code": "G9137", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG 3-4 NOT RELAP", "code_information": [{"code": "G9135", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL STG UNKNOWN", "code_information": [{"code": "G9138", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NHL TRANS TO LG BCELL", "code_information": [{"code": "G9136", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC DX UNKNOWN NOS", "code_information": [{"code": "G9067", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG2 NO PROGRES", "code_information": [{"code": "G9064", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3A NO PROGRE", "code_information": [{"code": "G9065", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STG3B-4 METASTA", "code_information": [{"code": "G9066", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX NSCLC STGI NO PROGRES", "code_information": [{"code": "G9063", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN RECURRENCE", "code_information": [{"code": "G9116", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B NO PR", "code_information": [{"code": "G9113", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG1A-B OR 2", "code_information": [{"code": "G9114", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN STG3/4 NOPROG", "code_information": [{"code": "G9115", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX OVARIAN UNKNOWN NOS", "code_information": [{"code": "G9117", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], 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"plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T2NO PROGRES", "code_information": [{"code": "G9078", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE T3B-T4NOPROG", "code_information": [{"code": "G9079", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE UNKNWN NOS", "code_information": [{"code": "G9083", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX PROSTATE W/RISE PSA", "code_information": [{"code": "G9080", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL EXTENT UNKNWN", "code_information": [{"code": "G9095", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL M1 W/METS PROG", "code_information": [{"code": "G9094", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-2 NO PROGR", "code_information": [{"code": "G9090", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T1-3,N1-2NOPRG", "code_information": [{"code": "G9092", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T3 N0 NO PROG", "code_information": [{"code": "G9091", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX RECTAL T4,N,M0 NO PRG", "code_information": [{"code": "G9093", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT AT DX", "code_information": [{"code": "G9069", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC EXT UNKNWN", "code_information": [{"code": "G9070", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC DX SCLC/NSCLC LIMITED", "code_information": [{"code": "G9068", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC EXPECTANT MANAGEMENT PT", "code_information": [{"code": "G9053", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC GASTRO 51 GENE NOMOGRAM", "code_information": [{"code": "7M", "type": "CPT"}], "standard_charges": [{"minimum": 339.67, "maximum": 1422.38, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", 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"ONC HL NEO GEN SEQ ALYS ALG", "code_information": [{"code": "364U", "type": "CPT"}], "standard_charges": [{"minimum": 1806.53, "maximum": 1806.53, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1806.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1806.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1806.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1806.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1806.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC HL NEO OPT 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 183.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 621.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 147.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 147.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 147.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 147.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 147.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNCH SYN GEN DNA SEQ ALY", "code_information": [{"code": "238U", "type": "CPT"}], "standard_charges": [{"minimum": 402.43, "maximum": 2218.53, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 402.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 447.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC LNG 3 PRTN BMRK PLSM ALG", "code_information": [{"code": "92U", "type": "CPT"}], "standard_charges": [{"minimum": 1711.81, "maximum": 9436.98, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1711.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1902.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 4MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315890", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 8MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308494", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 8MG DT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308494", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON ORAL", "code_information": [{"code": "Q0162", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2405", "type": "HCPCS"}, {"code": "5322936", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.38, "maximum": 0.38, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2405", "type": "HCPCS"}, {"code": "5322936", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.38, "maximum": 0.38, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED MILES", "code_information": [{"code": "P9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.29, "maximum": 4.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED TRIP", "code_information": [{"code": "P9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.86, "maximum": 42.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL 2 SURFACE", "code_information": [{"code": "D6612", "type": "HCPCS"}], "standard_charges": [{"minimum": 1268.11, "maximum": 1268.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1268.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL >=3 SURFA", "code_information": [{"code": "D6613", "type": "HCPCS"}], "standard_charges": [{"minimum": 1386.68, "maximum": 1386.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1386.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL 2 SRFC", "code_information": [{"code": "D6610", "type": "HCPCS"}], "standard_charges": [{"minimum": 1335.97, "maximum": 1335.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL >=3SRF", "code_information": [{"code": "D6611", "type": "HCPCS"}], "standard_charges": [{"minimum": 1410.84, "maximum": 1410.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1410.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL 2 SURFACES", "code_information": [{"code": "D6614", "type": "HCPCS"}], "standard_charges": [{"minimum": 1328.61, "maximum": 1328.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1328.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL >=3 SURFAC", "code_information": [{"code": "D6615", "type": "HCPCS"}], "standard_charges": [{"minimum": 1419.45, "maximum": 1419.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1419.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC 2 SURFACES", "code_information": [{"code": "D6608", "type": "HCPCS"}], "standard_charges": [{"minimum": 1301.95, "maximum": 1301.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1301.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC >=3 SURFACES", "code_information": [{"code": "D6609", "type": "HCPCS"}], "standard_charges": [{"minimum": 1394.04, "maximum": 1394.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1394.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONLAY TITANIUM", "code_information": [{"code": "D6634", "type": "HCPCS"}], "standard_charges": [{"minimum": 1386.68, "maximum": 1386.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1386.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5361.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1797.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5240.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1754.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6225.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2078.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6692.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2235.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6808.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2281.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN AXL/SUB ART ENDO PROS UNI", "code_information": [{"code": "4614715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11964.0, "discounted_cash": 8973.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2714.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3055.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1023.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN BX/EXC INGUINOFEM NODES", "code_information": [{"code": "38531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1633.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 547.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2868.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 966.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 814.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4397.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1474.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 656.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 219.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1107.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2774.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 928.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2456.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 821.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7750", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7230.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7230.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7650", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7006.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7006.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7630", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7341.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7341.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUC COMPD ALVEOLUS FX", "code_information": [{"code": "D7770", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4226.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7730", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 8564.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8564.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7533.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2519.52, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7240.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2423.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6656.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6656.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2229.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7538.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2519.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6895.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2312.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7735.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2589.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5982.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5982.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2002.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7307.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2446.3, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 31799.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2189.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5086.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1698.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3980.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1328.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2655.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE & SEPTAL FX", "code_information": [{"code": "21335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2628.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 874.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX UNCOMPLICATD", "code_information": [{"code": "21325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1632.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 542.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX W/SKELE FIXJ", "code_information": [{"code": "21330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1962.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 652.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4985.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1679.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN TX SEPTAL FX W/WO STABJ", "code_information": [{"code": "21336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2334.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 777.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2865.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2869.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST AR", "code_information": [{"code": "4617236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27266.0, "discounted_cash": 20449.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST AR", "code_information": [{"code": "4917236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25248.0, "discounted_cash": 18936.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST VN", "code_information": [{"code": "4617238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 68104.0, "discounted_cash": 51078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST 1ST VN", "code_information": [{"code": "4917238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20678.0, "discounted_cash": 15508.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD AR", "code_information": [{"code": "4617237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20504.0, "discounted_cash": 15378.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD VN", "code_information": [{"code": "4617239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 28296.0, "discounted_cash": 21222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERC PL ST E/ADD VN", "code_information": [{"code": "4917239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27034.0, "discounted_cash": 20275.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT 1ST", "code_information": [{"code": "37236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 25566.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1553.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2365.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3124.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2365.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 743.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1108.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1475.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1108.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 17439.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 530.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1612.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1958.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1612.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 17218.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1083.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3219.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3913.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3219.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 32.34, "maximum": 178.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 32.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 35.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 178.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 42.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 248.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 154.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 100.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 223.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 248.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 51.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 194.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 164.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 66.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 175.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 194.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 341.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 210.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 135.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 307.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 341.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 229.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 182.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 206.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 229.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 317.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC MITOMYCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7315", "type": "HCPCS"}], "standard_charges": [{"minimum": 1427.12, "maximum": 1427.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1427.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 39.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES", "code_information": [{"code": "80361", "type": "CPT"}, {"code": "7250361", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 71.0, "discounted_cash": 53.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES/2", "code_information": [{"code": "80361", "type": "CPT"}, {"code": "7253506", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 613.0, "discounted_cash": 459.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES/3", "code_information": [{"code": "80361", "type": "CPT"}, {"code": "7253926", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 80.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS/OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}, {"code": "7250001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIOIDS/OPIATE ANALOGS 5+", "code_information": [{"code": "80364", "type": "CPT"}, {"code": "7250387", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 60.42, "gross_charge": 183.0, "discounted_cash": 137.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIUM 10% TINC PER DS LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327831", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIUM 10% TINC PER DS LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5327831", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1050.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 350.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1312.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 454.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 725.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS CNDT CRTJ", "code_information": [{"code": "34714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 950.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 317.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN ILAC ART EXPOS CNDT CRTJ", "code_information": [{"code": "34833", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1382.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1184.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 396.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 43584.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2206.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 740.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA NEUROMUSCULAR", "code_information": [{"code": "64580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1151.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 386.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA PERPH NERVE", "code_information": [{"code": "64575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1150.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 385.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA SACRAL NERVE", "code_information": [{"code": "64581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20808.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2388.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 799.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBF", "code_information": [{"code": "817T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN INSJ/RPLCMT INS PTN SUBQ", "code_information": [{"code": "816T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 37711.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3055.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1021.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3938.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1328.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4641.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1559.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1935.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD ZYGOMATIC ARCH", "code_information": [{"code": "21356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1478.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 667.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3790.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1269.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3731.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1228.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4004.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1336.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2791.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 937.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX PERIORBITAL", "code_information": [{"code": "21386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2528.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 850.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2674.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3288.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1105.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/IMPLANT", "code_information": [{"code": "21407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2350.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/O IMPLANT", "code_information": [{"code": "21406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2137.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 718.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3665.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1228.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBTL IMPLT", "code_information": [{"code": "21390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2935.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 977.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPRELVEKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2355", "type": "HCPCS"}], "standard_charges": [{"minimum": 1619.31, "maximum": 1619.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1619.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 171.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 71.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 171.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 56.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTO-ACOUSTIC IMG BREAST UNI", "code_information": [{"code": "857T", "type": "CPT"}], "standard_charges": [{"minimum": 102.62, "maximum": 114.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 102.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 114.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 104.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"minimum": 71.69, "maximum": 71.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13.16, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPTX ACRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2398.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 801.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX ACROMCLV DISLC AQT/CHRN", "code_information": [{"code": "23550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2116.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 710.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX ACUTE SHOULDER DISLC", "code_information": [{"code": "23660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 727.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX CLAVICULAR FX W/INT FIX", "code_information": [{"code": "23515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2656.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 892.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX GR HMRL TBRS FX INT FIX", "code_information": [{"code": "23630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2878.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 967.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX MEDIAL ANKLE FX", "code_information": [{"code": "27766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2232.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 751.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2133.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 712.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX POST ANKLE FX", "code_information": [{"code": "27769", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2671.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX PROX HUMRL FX W/INT FIX", "code_information": [{"code": "23615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3245.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1090.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX PRX HMRL FX FIX RPR RPL", "code_information": [{"code": "23616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4516.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1513.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SCAPULAR FX W/INT FIXJ", "code_information": [{"code": "23585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3574.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1200.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC FX", "code_information": [{"code": "23670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3206.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1078.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3380.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1148.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2317.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2131.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4517.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1518.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL ANTRAL FISTULA CLOSURE", "code_information": [{"code": "D7260", "type": "HCPCS"}], "standard_charges": [{"minimum": 1333.51, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1333.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL BUSULFAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8510", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.71, "maximum": 91.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL DEXAMETHASONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8540", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.31, "maximum": 0.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL EVALUATION, PT < 3YRS", "code_information": [{"code": "D0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.33, "maximum": 89.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL EVEROLIMUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.43, "maximum": 10.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FLUDARABINE PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8562", "type": "HCPCS"}], "standard_charges": [{"minimum": 310.15, "maximum": 310.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 310.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 311.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 311.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL HIV-1/HIV-2 SCREEN", "code_information": [{"code": "G0435", "type": "HCPCS"}, {"code": "4120054", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.78, "maximum": 45.44, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL HYGIENE INSTRUCTION", "code_information": [{"code": "D1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.62, "maximum": 65.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL MED ADM DIRECT OBSERVE", "code_information": [{"code": "H0033", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL MR CONTRAST, 100 ML", "code_information": [{"code": "Q9954", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.23, "maximum": 44.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL NETUPITANT, PALONOSETRO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8655", "type": "HCPCS"}], "standard_charges": [{"minimum": 1555.35, "maximum": 1555.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1555.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 266.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL SURGERY PROCEDURE", "code_information": [{"code": "D7999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL/FACIAL PHOTO IMAGES", "code_information": [{"code": "D0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.72, "maximum": 88.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25516.49, "maximum": 53920.13, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27114.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27479.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26546.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25516.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42700.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53920.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14684.11, "maximum": 31029.7, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16853.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15813.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15276.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14684.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24573.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31029.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROSTHESIS", "code_information": [{"code": "D5915", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 14056.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14056.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL REPLACEMENT", "code_information": [{"code": "D5928", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 7028.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7028.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10460.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3487.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11903.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11903.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3958.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11515.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11515.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3826.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORBITS 4VW MIN", "code_information": [{"code": "70200", "type": "CPT"}, {"code": "4900152", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 143.27, "gross_charge": 1780.0, "discounted_cash": 1335.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 80.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 128.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 143.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY PARTIAL", "code_information": [{"code": "54522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2144.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY (FOWLER-STEPHENS)", "code_information": [{"code": "54650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2599.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 871.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY INGUN/SCROT APPR", "code_information": [{"code": "54640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 13611.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1573.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 529.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID SNG QNT", "code_information": [{"code": "83921", "type": "CPT"}, {"code": "7252125", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.45, "gross_charge": 513.0, "discounted_cash": 384.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL", "code_information": [{"code": "83919", "type": "CPT"}, {"code": "7258391", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.39, "gross_charge": 501.0, "discounted_cash": 375.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [{"code": "884", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1827.0, "maximum": 36898.51, "estimated_discounted_cash": 84277.51, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1827.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18804.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18166.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17461.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29220.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36898.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORION, PER SQ CM", "code_information": [{"code": "Q4276", "type": "HCPCS"}], "standard_charges": [{"minimum": 5609.85, "maximum": 5609.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5609.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORITAVANCIN (ORBA) PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2407", "type": "HCPCS"}, {"code": "5322970", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 104.67, "maximum": 104.67, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORITAVANCIN (ORBA) PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2407", "type": "HCPCS"}, {"code": "5322970", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 104.67, "maximum": 104.67, "gross_charge": 174.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORPHENADRINE 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308493", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORPHENADRINE 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308493", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORPHENADRINE TO 60MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2360", "type": "HCPCS"}, {"code": "5322946", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 36.81, "maximum": 36.81, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORPHENADRINE TO 60MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2360", "type": "HCPCS"}, {"code": "5322946", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 36.81, "maximum": 36.81, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTH BOOT NONPNEU PREFAB", "code_information": [{"code": "L4386", "type": "HCPCS"}, {"code": "8133203", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 690.55, "maximum": 690.55, "gross_charge": 2807.0, "discounted_cash": 2105.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 690.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTH FINGER RING PREFAB", "code_information": [{"code": "L3925", "type": "HCPCS"}, {"code": "8133225", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 260.47, "maximum": 260.47, "gross_charge": 732.0, "discounted_cash": 549.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.47, 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"CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.87, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "4153935", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.87, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "4173935", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.87, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "7253935", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.87, "gross_charge": 208.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSMOTIC FRAG RBC UNINC", "code_information": [{"code": "85555", "type": "CPT"}, {"code": "7255555", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.33, "gross_charge": 266.0, "discounted_cash": 199.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSSEOUS SURG 1 TO 3 TEETH", "code_information": [{"code": "D4261", "type": "HCPCS"}], "standard_charges": [{"minimum": 1015.2, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1015.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSSEOUS SURGERY 4 OR MORE", "code_information": [{"code": "D4260", "type": "HCPCS"}], "standard_charges": [{"minimum": 1308.09, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1308.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OST BLT A/S", "code_information": [{"code": "A4367", "type": "HCPCS"}, {"code": "8033055", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 38.08, "maximum": 38.08, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OST FLANGES CONVEX", "code_information": [{"code": "8033102", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2716.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 910.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE ALLOGRAFT", "code_information": [{"code": "27415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 30557.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5013.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1684.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE AUTOGRAFT", "code_information": [{"code": "27416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3590.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL TALUS AUTOGRFT", "code_information": [{"code": "28446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4478.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1504.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14068.74, "maximum": 29729.34, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18891.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15151.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14636.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14068.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23543.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29729.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21377.15, "maximum": 45173.1, "estimated_discounted_cash": 70820.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26626.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23021.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22239.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21377.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35773.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 45173.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8545.65, "maximum": 18058.23, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13429.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9203.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8890.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8545.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14300.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18058.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 55.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 168.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 72.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 212.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 212.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 253.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 253.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1 VRT SGM CRV", "code_information": [{"code": "22220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5911.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1993.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1289.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 433.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5780.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1942.87, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6441.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2159.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4329.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTOMY SUPPLY MISC", "code_information": [{"code": "A4421", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", 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PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5675.03, "maximum": 11992.19, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6111.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5904.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5675.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9496.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11992.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9703.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9703.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3260.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53694.13, "maximum": 113463.67, "estimated_discounted_cash": 348863.48, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 62287.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 106518.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57825.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55861.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 53694.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 89854.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 113463.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34181.52, "maximum": 72230.63, "estimated_discounted_cash": 264212.22, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 62287.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 64986.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 36811.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35561.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34181.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57201.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 72230.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10454.69, "maximum": 22092.32, "estimated_discounted_cash": 101785.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14005.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11259.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10876.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10454.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17495.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22092.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22630.68, "maximum": 47821.98, "estimated_discounted_cash": 108218.61, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27965.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24371.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23543.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22630.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37871.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47821.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7402.83, "maximum": 15643.28, "estimated_discounted_cash": 60331.72, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9047.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7972.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7701.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7402.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12388.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15643.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36255.53, "maximum": 76613.32, "estimated_discounted_cash": 225977.84, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41218.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 39044.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37718.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 36255.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 60671.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 76613.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10155.15, "maximum": 21459.34, "estimated_discounted_cash": 63872.05, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13764.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10936.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10564.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10155.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16994.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21459.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17357.2, "maximum": 36678.35, "estimated_discounted_cash": 121339.69, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24611.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18692.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18057.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17357.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29046.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36678.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7043.6, "maximum": 14884.17, "estimated_discounted_cash": 53017.88, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9577.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7585.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7327.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7043.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11787.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14884.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. 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"standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN MGT OPI USE GNOTYP PNL", "code_information": [{"code": "78U", "type": "CPT"}], "standard_charges": [{"minimum": 1710.3, "maximum": 1710.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1710.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALATAL LIFT PROSTHESIS", "code_information": [{"code": "D5955", "type": "HCPCS"}], "standard_charges": [{"minimum": 6766.71, "maximum": 6766.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6766.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE FULL GENE SEQ", "code_information": [{"code": "81307", "type": "CPT"}], "standard_charges": [{"minimum": 256.23, "maximum": 2565.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 256.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 284.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2565.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 608.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81308", "type": "CPT"}], "standard_charges": [{"minimum": 271.22, "maximum": 1143.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 272.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 303.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1143.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALB2 MRNA SEQ ALYS", "code_information": [{"code": "137U", "type": "CPT"}], "standard_charges": [{"minimum": 194.63, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 194.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 216.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIFERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2425", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.3, "maximum": 95.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 95.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PALINGEN XPLUS", "code_information": [{"code": "Q4173", "type": "HCPCS"}], "standard_charges": [{"minimum": 1453.66, "maximum": 1453.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1453.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PROMATRX", "code_information": [{"code": "Q4174", "type": "HCPCS"}], "standard_charges": [{"minimum": 1104.78, "maximum": 1104.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1104.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDN (INVEGA SUST) 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2426", "type": "HCPCS"}, {"code": "5323035", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 54.31, "maximum": 54.31, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDN (INVEGA SUST) 1MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2426", "type": "HCPCS"}, {"code": "5323035", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 54.31, "maximum": 54.31, "gross_charge": 59.0, "discounted_cash": 44.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 3MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308879", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 3MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308879", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 6MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308880", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 6MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308880", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 9MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308881", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIPERIDONE 9MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308881", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIVIZUMAB PER 50MG IJ", "code_information": [{"code": "90378", "type": "CPT"}, {"code": "5323057", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6773.62, "maximum": 6773.62, "gross_charge": 8754.0, "discounted_cash": 6565.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6773.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALIVIZUMAB PER 50MG IJ", "code_information": [{"code": "90378", "type": "CPT"}, {"code": "5323057", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6773.62, "maximum": 6773.62, "gross_charge": 8754.0, "discounted_cash": 6565.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6773.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALLIATIVE TX DENTAL PAIN", "code_information": [{"code": "D9110", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.09, "maximum": 136.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALONOSETRON HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2469", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.21, "maximum": 3.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAMIDRONATE PER 30MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2430", "type": "HCPCS"}, {"code": "5323060", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 33.66, "maximum": 33.66, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAMIDRONATE PER 30MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2430", "type": "HCPCS"}, {"code": "5323060", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 33.66, "maximum": 33.66, "gross_charge": 118.0, "discounted_cash": 88.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11305.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS TRANSPLANT", "code_information": [{"code": "10", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59512.91, "maximum": 164567.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 59512.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 83869.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 81020.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 77877.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 130325.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 164567.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31475.87, "maximum": 66513.19, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40890.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33897.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32746.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31475.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52673.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66513.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59371.34, "maximum": 125460.45, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 80693.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63939.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 61767.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 59371.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 99355.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 125460.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "407", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24089.32, "maximum": 50904.31, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28368.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25942.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25061.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24089.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 40312.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50904.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6814.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2279.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10409.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3479.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11200.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11200.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3741.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10454.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3495.14, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4878.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4878.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1634.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 12-38-60 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306608", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 12-38-60 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5306608", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 20.0, "discounted_cash": 15.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 24-76-120 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304421", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 24-76-120 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5304421", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 3-9.5-15 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308856", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 3-9.5-15 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308856", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCRELIP 6-19-30 XRCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": 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schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1287.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1193.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 576.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1158.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1287.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1180.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARATHYROID IMAGING", "code_information": [{"code": "78070", "type": "CPT"}, {"code": "5208031", "type": "CDM"}, {"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 843.3, "gross_charge": 5233.0, "discounted_cash": 3924.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 399.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 450.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 548.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 609.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 843.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 274.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL AMINO ACID 5.", "code_information": [{"code": "B4172", "type": "HCPCS"}], "standard_charges": [{"minimum": 174.93, "maximum": 174.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL HEPATIC FREAM", "code_information": [{"code": "B5200", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SUPP NOT OTHRWS C", "code_information": [{"code": "B9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARICALCITOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2501", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.52, "maximum": 2.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARIETAL CELL AB", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7250218", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 371.0, "discounted_cash": 278.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING/CUTG B9 HYPRKER LES 1", "code_information": [{"code": "11055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2032.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 56.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1979.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1819.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2997.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 996.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2232.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 742.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308949", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308949", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315960", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 10MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315960", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308950", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308951", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308951", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308952", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROXETINE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5308952", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART PULP FOR APEXOGENESIS", "code_information": [{"code": "D3222", "type": "HCPCS"}], "standard_charges": [{"minimum": 323.09, "maximum": 323.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3562.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1186.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF ANKLE/HEEL", "code_information": [{"code": "28120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1825.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 179.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 813.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 179.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1085.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1175.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 574.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 584.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 13611.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1575.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 712.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3243.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL AMPUTATION OF TOE", "code_information": [{"code": "28825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 23174.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 630.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 350.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 124.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC BONE HUMERUS", "code_information": [{"code": "24140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2592.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 872.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1364.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1284.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 595.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1311.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 615.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4133.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1388.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3516.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1172.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL MASTECTOMY", "code_information": [{"code": "19301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2406.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 805.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6736.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2251.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4033.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1350.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3565.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1194.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL COLLAR BONE", "code_information": [{"code": "23120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2179.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 731.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12914.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12914.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4332.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15425.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15425.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5172.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16978.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16978.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5693.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 21485.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1831.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 615.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FINGER BONE", "code_information": [{"code": "26236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 41934.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1644.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FOOT FASCIA", "code_information": [{"code": "28060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15245.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1330.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 626.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 162.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL LEG BONE(S)", "code_information": [{"code": "27360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3316.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1108.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3498.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1171.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4568.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1531.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4855.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4855.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1626.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6545.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6545.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2185.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5962.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1993.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6365.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6365.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2129.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5956.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5956.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1992.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7569.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2531.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6967.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6967.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2336.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17640.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17640.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5889.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11629.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11629.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3888.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12881.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12881.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4301.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10187.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10187.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3403.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9228.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3094.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16007.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16007.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5347.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1732.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1980.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 659.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FIBULA", "code_information": [{"code": "27641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2399.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 810.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 26548.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1620.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 10708.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1608.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 172.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 730.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 172.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HAND BONE", "code_information": [{"code": "26230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 16613.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1855.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7116.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7116.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2380.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8786.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2937.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HYMEN", "code_information": [{"code": "56700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 746.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4815.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1613.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7919.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7919.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2639.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8753.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8753.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2916.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7432.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2475.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7066.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2354.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6969.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2321.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7629.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7629.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2541.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1490.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 677.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8441.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8441.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2824.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11092.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11092.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3714.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11900.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11900.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3982.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5282.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5282.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1767.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2932.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 968.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2617.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 869.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5672.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5672.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1899.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5906.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5906.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1978.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11251.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11251.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3764.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PENIS", "code_information": [{"code": "54120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2309.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 774.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5156.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1716.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2164.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 729.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RADIUS", "code_information": [{"code": "25230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1613.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 543.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3942.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1315.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6563.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6563.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2199.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5588.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5588.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1869.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2077.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 704.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4414.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1480.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF SCAPULA", "code_information": [{"code": "23190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2130.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": [{"code": "21620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1832.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 613.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 39285.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2583.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 864.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 40263.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3425.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TIBIA", "code_information": [{"code": "27640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3051.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1019.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 22094.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1236.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 926.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 976.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 144.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 487.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 144.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 12487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 987.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 493.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3848.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1281.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4761.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4761.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1585.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1866.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1603.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 539.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF VULVA", "code_information": [{"code": "56620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2160.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 717.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3839.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1272.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2583.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 866.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3725.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1248.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT AB EA", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "4106005", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.77, "gross_charge": 736.0, "discounted_cash": 552.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT AB EA", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "4126005", 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"facility"}]}, {"description": "PCA3/KLK3 ANTIGEN", "code_information": [{"code": "81313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 967.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 371.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 264.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 293.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 967.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 229.55, "methodology": "fee schedule"}, {"payer_name": 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"code_information": [{"code": "81314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1249.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 470.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 334.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 371.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1249.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES PHYS/QHP", "code_information": [{"code": "96573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 824.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 824.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PDT DSTR PRMLG LES SKN", "code_information": [{"code": "96567", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 497.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 159.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PE 10% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331822", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PE 2.5% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331829", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PE 2.5% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331829", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PE 2.5% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331828", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PE NASAL .25% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331794", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL .25% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331794", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL .5% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331808", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL .5% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331808", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL 1% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331816", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL 1% 15ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331816", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL 1% 30ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331781", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PE NASAL 1% 30ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5331781", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PE/CYCLOPENT 1-.2%2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331842", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 147.0, "discounted_cash": 110.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI", "code_information": [{"code": "165U", "type": "CPT"}], "standard_charges": [{"minimum": 315.92, "maximum": 1759.04, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 315.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 351.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1759.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 417.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI CLIN RX", "code_information": [{"code": "178U", "type": "CPT"}], "standard_charges": [{"minimum": 313.26, "maximum": 1744.25, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 313.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 348.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1744.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 413.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 INIT", "code_information": [{"code": "99475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2022.5, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2022.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 676.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE AGE 2-5 SUBSQ", "code_information": [{"code": "99476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1217.44, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1217.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT", "code_information": [{"code": "99466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 841.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 841.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRIT CARE TRANSPORT ADDL", "code_information": [{"code": "99467", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 422.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 422.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 140.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE INITIAL", "code_information": [{"code": "99471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2810.84, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2810.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 932.14, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED CRITICAL CARE SUBSQ", "code_information": [{"code": "99472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1438.04, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1438.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 482.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED FBRL KD IFI27&MCEMP1 RNA", "code_information": [{"code": "389U", "type": "CPT"}], "standard_charges": [{"minimum": 63.18, "maximum": 63.18, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC COMPL", "code_information": [{"code": "94774", "type": "CPT"}], "standard_charges": [{"minimum": 1148.37, "maximum": 1148.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1148.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC DOWNLD", "code_information": [{"code": "94776", "type": "CPT"}], "standard_charges": [{"minimum": 859.04, "maximum": 859.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 859.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC HK-UP", "code_information": [{"code": "94775", "type": "CPT"}], "standard_charges": [{"minimum": 179.9, "maximum": 179.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC REPORT", "code_information": [{"code": "94777", "type": "CPT"}], "standard_charges": [{"minimum": 108.18, "maximum": 108.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED POWER WHEELCHAIR NOS", "code_information": [{"code": "E1239", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER LG", "code_information": [{"code": "T4530", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE BRIEF/DIAPER SM/MED", "code_information": [{"code": "T4529", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON LG", "code_information": [{"code": "T4532", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED SIZE PULL-ON SM/MED", "code_information": [{"code": "T4531", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED VSCLTS KD ALYS 3 BMRKS", "code_information": [{"code": "310U", "type": "CPT"}], "standard_charges": [{"minimum": 268.85, "maximum": 1482.11, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 268.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 298.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1482.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 351.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PED WHL GEN MTHYLTN ALYS 50+", "code_information": [{"code": "318U", "type": "CPT"}], "standard_charges": [{"minimum": 1206.08, "maximum": 6715.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1206.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1340.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6715.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1593.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDCLE FH/CH/CH/M/N/AX/G/H/F", "code_information": [{"code": "15574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2700.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1050.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC PARTIAL DENTURE FX", "code_information": [{"code": "D6985", "type": "HCPCS"}], "standard_charges": [{"minimum": 1133.77, "maximum": 1133.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1133.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC SPEECH AID", "code_information": [{"code": "D5952", "type": "HCPCS"}], "standard_charges": [{"minimum": 3123.23, "maximum": 3123.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3123.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC WHEELCHAIR NOS", "code_information": [{"code": "E1229", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEDICLE E/N/E/L/NTRORAL", "code_information": [{"code": "15576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2363.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 141.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 958.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 141.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDICLE SOFT TISSUE GRAFT PR", "code_information": [{"code": "D4270", "type": "HCPCS"}], "standard_charges": [{"minimum": 998.36, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 998.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2A/180", "code_information": [{"code": "S0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 3390.18, "maximum": 3390.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3390.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG INTERFERON ALFA-2B/10", "code_information": [{"code": "S0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 584.84, "maximum": 584.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 584.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1012.0, "discounted_cash": 759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEGADEMASE BOVINE, 25 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2504", "type": "HCPCS"}], "standard_charges": [{"minimum": 1395.67, "maximum": 1395.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1395.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGAPTANIB SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2503", "type": "HCPCS"}], "standard_charges": [{"minimum": 2979.41, "maximum": 2979.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2979.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGASPARGASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9266", "type": "HCPCS"}], "standard_charges": [{"minimum": 97789.07, "maximum": 97789.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 97789.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 464.79, "maximum": 464.79, "gross_charge": 1529.0, "discounted_cash": 1146.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 464.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGFILGRASTIM-JMDB PER 0.5MGIJ", "code_information": [{"code": "Q5108", "type": "HCPCS"}, {"code": "5323097", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 464.79, "maximum": 464.79, "gross_charge": 1529.0, "discounted_cash": 1146.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 464.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGINESATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0890", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.88, "maximum": 35.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGLOTICASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2507", "type": "HCPCS"}], "standard_charges": [{"minimum": 12786.49, "maximum": 12786.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12786.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGUNIGALSIDASE ALFA-IWXJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2508", "type": "HCPCS"}], "standard_charges": [{"minimum": 686.23, "maximum": 686.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 686.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23116.89, "maximum": 48849.42, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37448.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24895.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24049.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23116.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38685.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48849.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC", "code_information": [{"code": "735", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14602.71, "maximum": 30857.7, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17868.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15726.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15192.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14602.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24436.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30857.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "57410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 387.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 129.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "99459", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9910.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3296.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3889.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1306.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3670.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1234.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIS 1 VIEW", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "4902170", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.97, "gross_charge": 1316.0, "discounted_cash": 987.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 76.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 84.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIS MIN 3 VWS", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "4902190", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 139.6, "gross_charge": 1642.0, "discounted_cash": 1231.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 71.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 125.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 139.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 66.67, "maximum": 66.67, "gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BE/PR PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}, {"code": "5323135", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 66.67, "maximum": 66.67, "gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 82.42, "maximum": 82.42, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G BENZ PER 100KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}, {"code": "5323121", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 82.42, "maximum": 82.42, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G K UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323151", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.92, "maximum": 2.92, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G K UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "5323151", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.92, "maximum": 2.92, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G NA PED PER 1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5323152", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G PROC UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2510", "type": "HCPCS"}, {"code": "5323173", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 164.53, "maximum": 164.53, "gross_charge": 211.0, "discounted_cash": 158.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN G PROC UPTO 600KU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2510", "type": "HCPCS"}, {"code": "5323173", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 164.53, "maximum": 164.53, "gross_charge": 211.0, "discounted_cash": 158.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309025", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309025", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309029", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309029", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G NA 5MU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5323153", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 308.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN VK 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315994", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN VK 500MG/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315994", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN VK125M/5MPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315987", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN VK125M/5MPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5315987", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE IMP", "code_information": [{"code": "C2622", "type": "HCPCS"}, {"code": "8154000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 57310.0, "discounted_cash": 42982.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENILE PROS IMPL", "code_information": [{"code": "C2622", "type": "HCPCS"}, {"code": "8154010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2933.0, "discounted_cash": 2199.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 211.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1771.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGERY", "code_information": [{"code": "54360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2627.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 880.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25256.02, "maximum": 53369.71, "estimated_discounted_cash": 77093.7, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31091.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27199.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26275.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25256.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42264.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15207.22, "maximum": 32135.12, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18865.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16377.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15820.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15207.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25448.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32135.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2545", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.07, "maximum": 198.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 198.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE PER 300MG IJ", "code_information": [{"code": "S0080", "type": "HCPCS"}, {"code": "5323189", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 185.29, "maximum": 185.29, "gross_charge": 652.0, "discounted_cash": 489.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTASTARCH 10% SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2513", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.92, "maximum": 57.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTAZOCINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3070", "type": "HCPCS"}], "standard_charges": [{"minimum": 411.12, "maximum": 411.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 411.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOBARBIT PER 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2515", "type": "HCPCS"}, {"code": "5327901", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 85.72, "maximum": 85.72, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOBARBIT PER 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2515", "type": "HCPCS"}, {"code": "5327901", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 85.72, "maximum": 85.72, "gross_charge": 356.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOSTATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9268", "type": "HCPCS"}], "standard_charges": [{"minimum": 8622.07, "maximum": 8622.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8622.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOXIFYLLN 400MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOXIFYLLN 400MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER COR REVAS CABG ADDL", "code_information": [{"code": "C9605", "type": "HCPCS"}, {"code": "4619605", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", 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3.79, "maximum": 3.79, "gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERAMPANEL 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309070", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC ASP VRT DISC FOR DX", "code_information": [{"code": "4910162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC ASP VRT DISC FOR DX", "code_information": [{"code": "5052997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23046.0, "discounted_cash": 17284.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG 1 BD LUMB/IMG", "code_information": [{"code": "4919720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25462.0, "discounted_cash": 19096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG 1 BD THOR/IMG", "code_information": [{"code": "4919718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25462.0, "discounted_cash": 19096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC AUG ADD T/L IMG", "code_information": [{"code": "4919719", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11161.0, "discounted_cash": 8370.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BILIARY BRUSH BIOPS", "code_information": [{"code": "4914306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16706.0, "discounted_cash": 12529.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "4918500", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3609.0, "discounted_cash": 2706.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "5057516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BIOPSY LYMPH NODE", "code_information": [{"code": "5068505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4249.0, "discounted_cash": 3186.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC CATH PORTAL VEIN", "code_information": [{"code": "4910163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1643.0, "discounted_cash": 1232.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CHOLECYSTOSTOMY", "code_information": [{"code": "4917600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8485.0, "discounted_cash": 6363.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CHOLECYSTOSTOMY", "code_information": [{"code": "5057490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8485.0, "discounted_cash": 6363.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CHOLECYSTOSTOMY", "code_information": [{"code": "5067490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8485.0, "discounted_cash": 6363.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC CLS INTRATRL W IMPL", "code_information": [{"code": "93580", "type": "CPT"}, {"code": "4613579", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92259.75, "gross_charge": 123013.0, "discounted_cash": 92259.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 79958.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 49205.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3448.67, "methodology": 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"case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC CLS INTRATRL W IMPL", "code_information": [{"code": "93580", "type": "CPT"}, {"code": "4613579", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 92259.75, "gross_charge": 123013.0, "discounted_cash": 92259.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 79958.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 49205.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3448.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 92259.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1150.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC CLS VENT SEPT W IMP", "code_information": [{"code": "93581", "type": "CPT"}, {"code": "4613581", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78924.75, "gross_charge": 105233.0, "discounted_cash": 78924.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 78924.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1562.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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"standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-ELUT STNT ADDL", "code_information": [{"code": "C9601", "type": "HCPCS"}, {"code": "4619601", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED 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"both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE LIVR TUMR", "code_information": [{"code": "5067382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 24085.0, "discounted_cash": 18063.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE PULM TUMR+IMG", "code_information": [{"code": "5052998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20747.0, "discounted_cash": 15560.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data 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"plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "standard_charge_dollar": 30660.6, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 38325.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 38325.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 76651.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 76651.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 53656.05, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 45990.9, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 38325.75, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 61321.2, "methodology": "fee schedule"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 53656.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2620.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 114977.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 874.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "standard_charge_dollar": 76651.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "standard_charge_dollar": 76651.5, "methodology": "fee 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HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 38325.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC TRNSHEP PORT W/EVL", "code_information": [{"code": "75885", "type": "CPT"}, {"code": "4915886", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 7393.0, "discounted_cash": 5544.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1057.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 146.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 750.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 834.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 262.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR 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{"description": "PERC TRSHEP PORT WO/EVL", "code_information": [{"code": "75887", "type": "CPT"}, {"code": "4915888", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "gross_charge": 3693.0, "discounted_cash": 2769.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1062.2, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 148.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 762.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 846.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC VALVULOPLSTY AORTIC", "code_information": [{"code": "92986", "type": "CPT"}, {"code": "4610500", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26048.25, "gross_charge": 34731.0, "discounted_cash": 26048.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 22575.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 13892.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4712.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 26048.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1574.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC VERT 1 BD ADD/IMG", "code_information": [{"code": "4914480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17469.0, "discounted_cash": 13101.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC VERT 1 BD LSAC/IMG", "code_information": [{"code": "4914479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21171.0, "discounted_cash": 15878.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC VERT 1BD CTHOR/IMG", "code_information": [{"code": "4914478", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21171.0, "discounted_cash": 15878.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2627.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2989.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4210.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2989.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21846.0, "maximum": 94614.22, "estimated_discounted_cash": 310412.15, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21846.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 48218.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46581.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44774.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 74927.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 94614.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21846.0, "maximum": 75491.85, "estimated_discounted_cash": 278612.9, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21846.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38473.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37166.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35724.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 59783.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 75491.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES", "code_information": [{"code": "321", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21309.0, "maximum": 62398.83, "estimated_discounted_cash": 312212.29, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21309.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31800.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30720.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 29528.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49415.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 62398.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "322", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19133.84, "maximum": 40432.64, "estimated_discounted_cash": 213092.04, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21309.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20605.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19906.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19133.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32019.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40432.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "250", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21846.0, "maximum": 50053.46, "estimated_discounted_cash": 219007.14, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21846.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43539.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25509.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24642.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23686.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39638.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50053.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "251", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16219.81, "maximum": 34274.86, "estimated_discounted_cash": 167141.6, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21846.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29719.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17467.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16874.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16219.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27143.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34274.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS ISLET CELLTRANS", "code_information": [{"code": "G0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1115.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1896.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERFLUOROCARBON 7ML KT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336988", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3545.0, "discounted_cash": 2658.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERFLUTREN LIP MICRO 1ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}, {"code": "5358247", "type": "CDM"}, {"code": "255", "type": "RC"}], "standard_charges": [{"minimum": 159.91, "maximum": 159.91, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERFLUTREN LIP MICRO 1ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}, {"code": "5358247", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 159.91, "maximum": 159.91, "gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI-IMPLT CAPSLC BRST COMPL", "code_information": [{"code": "19371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2598.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 876.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "estimated_discounted_cash": 6046.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 831.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMG GUIDE", "code_information": [{"code": "4613016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6046.0, "discounted_cash": 4534.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERIODIC ASSESSMENT", "code_information": [{"code": "G2077", "type": "HCPCS"}], "standard_charges": [{"minimum": 462.18, "maximum": 462.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 462.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORAL EVALUATION", "code_information": [{"code": "D0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.43, "maximum": 62.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORTHODONTC TX VISIT", "code_information": [{"code": "D8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 273.44, "maximum": 273.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL MAINT PROCEDURES", "code_information": [{"code": "D4910", "type": "HCPCS"}], "standard_charges": [{"minimum": 163.29, "maximum": 163.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 163.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING & ROOT", "code_information": [{"code": "D4341", "type": "HCPCS"}], "standard_charges": [{"minimum": 409.04, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 409.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING 1-3TEETH", "code_information": [{"code": "D4342", "type": "HCPCS"}], "standard_charges": [{"minimum": 220.3, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 220.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11585.58, "maximum": 24482.04, "estimated_discounted_cash": 85283.78, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14233.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12476.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12053.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11585.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19387.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24482.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17719.69, "maximum": 37444.34, "estimated_discounted_cash": 73858.78, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20533.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19083.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18434.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17719.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29653.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37444.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7810.9, "maximum": 16505.6, "estimated_discounted_cash": 94947.74, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9871.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8411.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8126.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7810.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13071.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16505.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR", "code_information": [{"code": "41", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23862.49, "maximum": 50424.99, "estimated_discounted_cash": 199155.26, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30983.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25698.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24825.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23862.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39932.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50424.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "40", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41905.6, "maximum": 88552.76, "estimated_discounted_cash": 228821.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 55303.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 45129.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 43596.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 41905.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 70127.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 88552.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "42", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18750.73, "maximum": 39623.07, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27077.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20193.36, "methodology": "case rate"}, {"payer_name": "UNITED 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"inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 62473.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41736.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40319.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38754.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64854.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81895.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16659.35, "maximum": 35203.69, "estimated_discounted_cash": 61826.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22721.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17941.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17331.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16659.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27878.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 129.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", 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"maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 666.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [{"code": "243", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23126.66, "maximum": 48870.06, "estimated_discounted_cash": 174609.41, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36792.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38891.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24905.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24059.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23126.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38701.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48870.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34651.46, "maximum": 73223.68, "estimated_discounted_cash": 240920.03, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36792.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 54257.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37317.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 36049.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34651.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 57987.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 73223.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19616.8, "maximum": 41453.21, "estimated_discounted_cash": 129588.99, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 36792.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31403.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21126.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20408.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19616.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32827.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41453.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMETHRIN 1% 60ML TS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336996", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERMETHRIN 1% 60ML TS", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5336996", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERMETHRIN 5% 60GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336998", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMETHRIN 5% 60GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5336998", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 416.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309106", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309106", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 4MG ORAL", "code_information": [{"code": "Q0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.56, "maximum": 1.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309107", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309107", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 8MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309109", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 8MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309109", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3310", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.49, "maximum": 28.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 31.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1601.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5565.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6825.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5565.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 433.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 144.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3031.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1019.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ CERVICOTHORACIC INJECT", "code_information": [{"code": "22510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1560.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1414.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2095.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1414.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2761.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 921.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 737.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 356.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 294.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 428.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 294.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 225.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 441.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 441.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 178.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD US IMAG", "code_information": [{"code": "19286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 151.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 267.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 347.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 267.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 177.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 203.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3382.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM LUMBAR", "code_information": [{"code": "275T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LS&CVT INJ VERT BODIES", "code_information": [{"code": "C7505", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LUMB&THOR VERT AUG", "code_information": [{"code": "C7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LUMBOSACRAL INJECTION", "code_information": [{"code": "22511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1469.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1438.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2093.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1438.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 914.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1016.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 274.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 71574.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4076.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1365.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10974.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12193.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2533.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 849.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3076.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1045.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR UNI", "code_information": [{"code": "33902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2610.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT BI", "code_information": [{"code": "33901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2703.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 918.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2057.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC EACH ADDL", "code_information": [{"code": "33904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1033.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 350.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 830.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3596.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4275.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3596.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1508.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3879.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4777.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3879.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1553.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3858.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4832.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3858.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 750.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4328.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4979.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2943.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"minimum": 6955.0, "maximum": 7521.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7521.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4247.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2138.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2335.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSLUM CORONARY LITHOTR", "code_information": [{"code": "92972", "type": "CPT"}, {"code": "4610715", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26148.0, "gross_charge": 34864.0, "discounted_cash": 26148.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 22661.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 13945.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 523.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 26148.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 175.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2052.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1211.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 547.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2764.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 925.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21498.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9064.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1844.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21498.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5337.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6495.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5337.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21498.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9064.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21498.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1719.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5348.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6464.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5348.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21498.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9064.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21498.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 781.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2780.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3313.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2780.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN FREE", "code_information": [{"code": "80186", "type": "CPT"}, {"code": "7254045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.19, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN PER 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1165", "type": "HCPCS"}, {"code": "5323320", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.39, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN PER 50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1165", "type": "HCPCS"}, {"code": "5323320", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.39, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN TOTAL", "code_information": [{"code": "80185", "type": "CPT"}, {"code": "4102655", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.26, "gross_charge": 855.0, "discounted_cash": 641.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": 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"gross_charge": 119.0, "discounted_cash": 89.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.2, "methodology": "fee 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"standard_charges": [{"minimum": 1.0, "maximum": 366.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 366.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 430.81, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 430.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee 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"standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 65.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 345.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1293.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE 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"standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOREFRACTIVE KERATECTOMY", "code_information": [{"code": "S0810", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 189.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 189.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTOTHERAP KERATECT", "code_information": [{"code": "S0812", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/MNTR", "code_information": [{"code": "94626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 292.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 292.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 102.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/O MNTR", "code_information": [{"code": "94625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 269.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 269.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 193.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66.37, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 90.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 35.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 193.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 92.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 193.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 93.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS REVIEW OF MOTION TESTS", "code_information": [{"code": "96004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 390.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 390.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 129.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 124.75, "estimated_discounted_cash": 431.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 124.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICIAN STANDBY SERVICES", "code_information": [{"code": "99360", "type": "CPT"}], "standard_charges": [{"minimum": 213.39, "maximum": 213.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSIOLOGIC EXERCISE STUDY", "code_information": [{"code": "93464", "type": "CPT"}, {"code": "4613466", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3087.75, "gross_charge": 4117.0, "discounted_cash": 3087.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 2676.05, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1646.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 3087.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYSIOLOGIC EXERCISE STUDY", "code_information": [{"code": "93464", "type": "CPT"}, {"code": "4613466", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3087.75, "gross_charge": 4117.0, "discounted_cash": 3087.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 2676.05, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1646.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 3087.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYSOSTIGM 1MG/ML 2ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5323345", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE CMPD 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE CMPD 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316062", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "5323366", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 11.0, "maximum": 11.0, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADIONE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "5323366", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.0, "maximum": 11.0, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADN PED PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "5323365", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 11.0, "maximum": 11.0, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYTONADN PED PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "5323365", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.0, "maximum": 11.0, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3185.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1068.62, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3640.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4682.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4682.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1568.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4658.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4658.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1560.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4933.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4933.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1653.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3640.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4528.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4528.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1518.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1317.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 440.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIFLU F-18, DIA 1 MILLICURIE", "code_information": [{"code": "A9595", "type": "HCPCS"}], "standard_charges": [{"minimum": 2509.22, "maximum": 2509.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2509.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 247.35, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 248.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 276.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1336.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 445.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 1% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331906", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1179.0, "discounted_cash": 884.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 1% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331906", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1179.0, "discounted_cash": 884.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 1% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331913", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 1% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331913", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331927", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1209.0, "discounted_cash": 906.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331927", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1209.0, "discounted_cash": 906.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331934", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 2% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331934", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 4% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331948", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 4% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5331948", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309470", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PILOCARPINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309470", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIMAVANSERIN 34MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309472", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 737.0, "discounted_cash": 552.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIMAVANSERIN 34MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309472", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 737.0, "discounted_cash": 552.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIMOZIDE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309475", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIMOZIDE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309475", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN BUTTRESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1135.0, "discounted_cash": 851.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CERCLAGE POSITION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1524.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 387.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FINGER DISLOCATION", "code_information": [{"code": "26776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1680.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN FINGER FRACTURE EACH", "code_information": [{"code": "26756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1587.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN FIXATION PROVISIONAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2193.0, "discounted_cash": 1644.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HALF THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2722.0, "discounted_cash": 2041.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HAND DISLOCATION", "code_information": [{"code": "26676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1903.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN HOFMAN TRNFX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11741.0, "discounted_cash": 8805.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN KNOWLES AS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1403.0, "discounted_cash": 1052.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN KNUCKLE DISLOCATION", "code_information": [{"code": "26706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1671.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN RADIOULNAR DISLOCATION", "code_information": [{"code": "25671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1993.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 670.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN SERVICE 60M PER MONTH", "code_information": [{"code": "G0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 182.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 97.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SRV ADD 30 MIN PR M", "code_information": [{"code": "G0024", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 127.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 61.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STEINMAN II W/HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2839.0, "discounted_cash": 2129.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN THR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1911.0, "discounted_cash": 1433.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TRANSFIX SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TYPE I", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3989.0, "discounted_cash": 2991.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TYPE II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TYPE III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2270.0, "discounted_cash": 1702.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TYPE IV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5558.0, "discounted_cash": 4168.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ULNAR STYLOID FRACTURE", "code_information": [{"code": "25651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1830.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 614.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1670.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 713.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINDOLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309484", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINDOLOL 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309484", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}, {"code": "4107144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 318.0, "discounted_cash": 238.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}, {"code": "4157144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}, {"code": "4177173", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.84, "maximum": 16.2, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309500", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309500", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309502", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 30MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309502", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 45MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309504", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIOGLITAZONE 45MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309504", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 106.0, "discounted_cash": 79.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPER/TAZ PER1.125GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "5323412", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPER/TAZ PER1.125GM IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "5323412", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPER/TAZPER1.125GMPMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "5323411", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPER/TAZPER1.125GMPMXIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "5323411", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIROXICAM 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309530", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIROXICAM 10MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309530", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2197.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1122.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1308.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 601.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 668.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2197.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 521.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PK STROKE FAST TREVO", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8176050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 91649.0, "discounted_cash": 68736.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PKNG NASAL MEROGEL", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "8240277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 74346.0, "discounted_cash": 55759.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PL DUODNOSTMY TBE WFLUOR", "code_information": [{"code": "4919441", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12256.0, "discounted_cash": 9192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PL GASTRO TUBE W/FLUORO", "code_information": [{"code": "4919440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8459.0, "discounted_cash": 6344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PL GASTRO TUBE W/FLUORO", "code_information": [{"code": "5050023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8459.0, "discounted_cash": 6344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PL ST CERV CAROTD WO/PRD", "code_information": [{"code": "4917216", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 47192.0, "discounted_cash": 35394.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PL VERT/THORAC STNT ADDL", "code_information": [{"code": "4910076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25152.0, "discounted_cash": 18864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PL VERT/THORAC STNT INIT", "code_information": [{"code": "4910075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48174.0, "discounted_cash": 36130.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PL/VERT/THORAC STNT INIT", "code_information": [{"code": "4610075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48174.0, "discounted_cash": 36130.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 336.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1155.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 578.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1040.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 578.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 21195.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1314.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1755.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2430.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1755.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1016.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 979.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1438.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 979.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 14928.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1171.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1391.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1995.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1391.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 886.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1085.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1556.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1085.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 21082.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1161.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1307.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1893.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1307.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 707.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 811.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1133.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 811.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1306.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1703.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2369.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1703.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "4910012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16570.0, "discounted_cash": 12427.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 430.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 492.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 679.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 467.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 673.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 893.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 673.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 536.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 651.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 902.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 651.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 608.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 690.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 969.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 690.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 755.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 847.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1203.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 847.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 965.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 818.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1240.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 818.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1181.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1523.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2167.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1523.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 163.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 163.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15429.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 443.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 613.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 443.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 661.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 924.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 661.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10599.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 616.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 679.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 679.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 740.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 604.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 918.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 604.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE IMPACTED TOOTH", "code_information": [{"code": "D7283", "type": "HCPCS"}], "standard_charges": [{"minimum": 846.98, "maximum": 846.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 860.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 741.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1124.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 741.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2559.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2227.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 746.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3797.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1272.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8459.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 724.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 646.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 966.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 646.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1222.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 415.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6008.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 22.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 22.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1676.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 567.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 758.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3538.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3538.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARKER PROS", "code_information": [{"code": "55876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10237.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 371.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 181.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4048.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1345.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8317.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8317.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2784.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON", "code_information": [{"code": "46020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 424.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACENTAL LACTOGEN", "code_information": [{"code": "83632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLAELET RICH PLASMA UNIT", "code_information": [{"code": "P9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 2081.6, "maximum": 2081.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2081.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA PROTEIN FRACT,5%,50ML", "code_information": [{"code": "P9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.86, "maximum": 50.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 252.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 146.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 348.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 387.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1305.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 125.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 160.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 300.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 334.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 222.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMALYTE A 1000ML IVF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5412720", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 367.0, "discounted_cash": 275.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASMAPROTEIN FRACT,5%,250ML", "code_information": [{"code": "P9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.94, "maximum": 102.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTAZOTE SANDAL EACH", "code_information": [{"code": "L3265", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.44, "maximum": 48.44, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY NECK", "code_information": [{"code": "15819", "type": "CPT"}], "standard_charges": [{"minimum": 2919.24, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2919.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLATE 3D 10X10H UP FACE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51629.0, "discounted_cash": 38721.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE AO SPECIAL TYP2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4474.0, "discounted_cash": 3355.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OTHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26847.0, "discounted_cash": 20135.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE ULNAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9980.0, "discounted_cash": 7485.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATELET AB", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "7026014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.68, "gross_charge": 1231.0, "discounted_cash": 923.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AB", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "7256014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.68, "gross_charge": 509.0, "discounted_cash": 381.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.67, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", 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"plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 262.22, "maximum": 1105.13, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 263.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 293.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1105.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLERIXAFOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2562", "type": "HCPCS"}], "standard_charges": [{"minimum": 655.75, "maximum": 655.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 655.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLETHSYMOGRAPHY LUNG VOL", "code_information": [{"code": "94726", "type": "CPT"}, {"code": "5504726", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 160.75, "gross_charge": 1091.0, "discounted_cash": 818.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE FLUSH/WIRE", "code_information": [{"code": "4912992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3396.0, "discounted_cash": 2547.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "4912557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18619.0, "discounted_cash": 13964.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "5052557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18619.0, "discounted_cash": 13964.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL DRAINAGE PERC", "code_information": [{"code": "5062557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 18619.0, "discounted_cash": 13964.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10734.7, "maximum": 22684.02, "estimated_discounted_cash": 58143.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15575.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11560.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11167.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10734.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17964.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22684.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16914.4, "maximum": 35742.64, "estimated_discounted_cash": 86734.69, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22512.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18215.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17597.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16914.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28305.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35742.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7783.77, "maximum": 16448.26, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11085.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8382.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8097.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7783.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13025.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16448.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLICAMYCIN (MITHRAMYCIN) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9270", "type": "HCPCS"}], "standard_charges": [{"minimum": 374.52, "maximum": 374.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 374.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1189.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 855.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1365.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 855.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 933.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 927.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1351.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 927.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1306.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 939.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1491.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 939.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "estimated_discounted_cash": 39885.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 728.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 724.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1054.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 724.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 903.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 902.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1313.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 902.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1403.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4075.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4827.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5029.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 290.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 290.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 264.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 344.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 264.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 724.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 813.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1151.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 813.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 874.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1297.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 874.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1213.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1028.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1556.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1028.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1133.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 378.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4105576", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.48, "gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4125574", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.48, "gross_charge": 44.0, "discounted_cash": 33.0, 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"plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4155576", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.48, "gross_charge": 148.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.71, "methodology": 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT AGGREGATION EA AGENT", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "4175576", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 94.48, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": 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{"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2287.0, "discounted_cash": 1715.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT CALCANEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11638.0, "discounted_cash": 8728.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT CERV SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11359.0, "discounted_cash": 8519.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT CERV STD MULTI LEVL ULRICH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11359.0, "discounted_cash": 8519.25, "setting": "both", 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"type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19980.0, "discounted_cash": 14985.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT COMPRESSION 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16572.0, "discounted_cash": 12429.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT CONDYLAR TIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2678.0, "discounted_cash": 2008.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLT CRANI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8133702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2968.0, "discounted_cash": 2226.0, "setting": "both", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 183.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE FULL SEQ ANALYSIS", "code_information": [{"code": "81317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2565.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1113.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 120.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1255.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 297.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PMS2 MRNA SEQ ALYS", "code_information": [{"code": "161U", "type": "CPT"}], "standard_charges": [{"minimum": 192.7, "maximum": 1072.96, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 192.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 214.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1072.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNE FLU HEPB COV HOME ADMIN", "code_information": [{"code": "M0201", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.72, "maximum": 143.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOC 13 VAL VACC IJ", "code_information": [{"code": "90670", "type": "CPT"}, {"code": "5323447", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 978.55, "maximum": 978.55, "gross_charge": 637.0, "discounted_cash": 477.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 978.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOC23 VAL VACC IJ", "code_information": [{"code": "90732", "type": "CPT"}, {"code": "5323449", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 506.26, "maximum": 506.26, "gross_charge": 694.0, "discounted_cash": 520.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 506.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOCCAL 20-VALENT VACCINE", "code_information": [{"code": "90677", "type": "CPT"}, {"code": "5323451", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1094.9, "maximum": 1094.9, "gross_charge": 1166.0, "discounted_cash": 874.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1094.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOCCAL VACC ADMIN", "code_information": [{"code": "G0009", "type": "HCPCS"}, {"code": "6100009", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOCOCCAL VACC ADMIN", "code_information": [{"code": "G0009", "type": "HCPCS"}, {"code": "6160009", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 121.45, "maximum": 121.45, "gross_charge": 166.0, "discounted_cash": 124.5, "setting": "both", 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10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11930.7, "maximum": 25211.35, "estimated_discounted_cash": 87143.3, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14691.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12848.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12412.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11930.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19965.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25211.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19145.78, "maximum": 40457.87, "estimated_discounted_cash": 102933.38, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": 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"setting": "both", "billing_class": "facility"}]}, {"description": "POSACONAZOLE", "code_information": [{"code": "80187", "type": "CPT"}, {"code": "7250011", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.4, "maximum": 102.83, "gross_charge": 366.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 27.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSACONAZOLE 100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309635", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSACONAZOLE 100MG XRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309635", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 193.0, "discounted_cash": 144.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSACONAZOLE 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316082", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 521.0, "discounted_cash": 390.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSACONAZOLE 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316082", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 521.0, "discounted_cash": 390.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5073.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1688.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92532", "type": "CPT"}], "standard_charges": [{"minimum": 65.62, "maximum": 65.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST 1 SRFC RESINBASED CMPST", "code_information": [{"code": "D2391", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.22, "maximum": 168.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST 2 SRFC RESINBASED CMPST", "code_information": [{"code": "D2392", "type": "HCPCS"}], "standard_charges": [{"minimum": 337.61, "maximum": 337.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST 3 SRFC RESINBASED CMPST", "code_information": [{"code": "D2393", "type": "HCPCS"}], "standard_charges": [{"minimum": 456.18, "maximum": 456.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 456.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST >=4SRFC RESINBASE CMPST", "code_information": [{"code": "D2394", "type": "HCPCS"}], "standard_charges": [{"minimum": 481.64, "maximum": 481.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST AND CORE CAST + CROWN", "code_information": [{"code": "D2952", "type": "HCPCS"}], "standard_charges": [{"minimum": 675.27, "maximum": 675.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 675.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST D/C H VST NEW PT 20 M", "code_information": [{"code": "G2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 181.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 60.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST REMOVAL", "code_information": [{"code": "D2955", "type": "HCPCS"}], "standard_charges": [{"minimum": 337.61, "maximum": 337.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST TAPER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32170.0, "discounted_cash": 24127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POST TAPR UNI KN PFJ ARTHRO CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2337.0, "discounted_cash": 1752.75, "setting": "both", "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7862.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7862.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "POST X TITN", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "4014355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1574.02, "maximum": 1574.02, "gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.36, "maximum": 94.83, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 30M", "code_information": [{"code": "G2014", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 271.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 60M", "code_information": [{"code": "G2015", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 380.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309731", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRB CRYO", "code_information": [{"code": "C2618", "type": "HCPCS"}, {"code": "8176127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11920.0, "discounted_cash": 8940.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1023.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 342.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 876.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRE-ALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "4104176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.34, "gross_charge": 481.0, "discounted_cash": 360.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRE-ALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "4124176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 55.34, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.33, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.91, 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"PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}, {"code": "7254140", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 78.4, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 40.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 51013.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51013.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2507.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2488.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2391.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3896.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4920.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30.0, "maximum": 30779.93, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 30779.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1840.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1825.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1754.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2860.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3611.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "PRENATAL AT RISK EDUCATION", "code_information": [{"code": "H1003", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREORTHODONTIC TX VISIT", "code_information": [{"code": "D8660", "type": "HCPCS"}], "standard_charges": [{"minimum": 363.29, "maximum": 363.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 363.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 765.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 410.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1369.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 459.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 978.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 327.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1363.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1826.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 797.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1368.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1171.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 392.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 924.43, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 924.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 842.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 281.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 765.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 679.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 227.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 643.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 775.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 258.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREP TUM CAV IORT PRIM CRNOT", "code_information": [{"code": "735T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 250.38, "maximum": 250.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 397.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 213.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 797.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1539.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1320.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 765.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 749.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2573.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 170.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1085.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 170.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6333.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 405.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2632.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 405.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4256.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 302.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1815.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 302.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4802.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2064.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4408.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 343.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1901.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 343.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4066.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 335.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1789.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 335.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3759.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 349.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1694.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 349.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4349.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1933.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 381.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1765.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 208.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 842.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 208.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4667.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 311.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1953.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 311.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4667.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 311.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1953.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 311.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3736.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 258.87, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6203.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2077.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 289.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 671.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 590.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 197.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPUTIAL STRETCHING", "code_information": [{"code": "54450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 206.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRESBYOPIA CORRECT FUNCT", "code_information": [{"code": "V2788", "type": "HCPCS"}, {"code": "8122172", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 3036.0, "discounted_cash": 2277.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 763.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 255.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/CHEM EA", "code_information": [{"code": "86970", "type": "CPT"}, {"code": "7026213", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 101.73, "gross_charge": 282.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/CHEM EA", "code_information": [{"code": "86970", "type": "CPT"}, {"code": "7256970", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 101.73, "gross_charge": 308.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}, {"code": "7026976", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.91, "maximum": 142.88, "gross_charge": 452.0, "discounted_cash": 339.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/DENSITY", "code_information": [{"code": "86972", "type": "CPT"}, {"code": "7250220", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.91, "maximum": 142.88, "gross_charge": 491.0, "discounted_cash": 368.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/ENZYM EA", "code_information": [{"code": "86971", "type": "CPT"}, {"code": "7026018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 262.13, "gross_charge": 261.0, "discounted_cash": 195.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRETX RBC AB W/ENZYM EA", "code_information": [{"code": "86971", "type": "CPT"}, {"code": "7256971", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 262.13, "gross_charge": 284.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", 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"PREV VISIT NEW AGE 40-64", "code_information": [{"code": "99386", "type": "CPT"}], "standard_charges": [{"minimum": 31.01, "maximum": 413.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 413.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREV VISIT NEW AGE 5-11", "code_information": [{"code": "99383", "type": "CPT"}], "standard_charges": [{"minimum": 31.01, "maximum": 301.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": 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"fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 140.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IMPLTBL SYS", "code_information": [{"code": "93260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS REMOTE", "code_information": [{"code": "650T", "type": "CPT"}], "standard_charges": [{"minimum": 74.8, "maximum": 74.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"minimum": 109.73, "maximum": 109.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 109.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL CARDIAC MODULJ", "code_information": [{"code": "417T", "type": "CPT"}], "standard_charges": [{"minimum": 301.35, "maximum": 301.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 154.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 165.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 165.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVL LDLS PM 1CHMBR IP", "code_information": [{"code": "826T", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRGRMG IO RTA ELTRD RA", "code_information": [{"code": "472T", "type": "CPT"}], "standard_charges": [{"minimum": 320.74, "maximum": 320.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 320.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 24311.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1522.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1314.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1967.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1314.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 574.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 321.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 550.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 321.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIMAQUINE 26.3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309809", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMAQUINE 26.3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309809", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMARY CLOSURE SINUS PERF", "code_information": [{"code": "D7261", "type": "HCPCS"}], "standard_charges": [{"minimum": 1167.75, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1167.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 4X4 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242810", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 343.0, "discounted_cash": 257.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 4X4 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242810", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 343.0, "discounted_cash": 257.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 6X6 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242814", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 379.0, "discounted_cash": 284.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 6X6 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242814", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 379.0, "discounted_cash": 284.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 8X12 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242812", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 387.0, "discounted_cash": 290.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 8X12 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242812", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 387.0, "discounted_cash": 290.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 8X8 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242811", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX 8X8 PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "8242811", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX AG PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "4028570", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX AG PER SQ CM", "code_information": [{"code": "Q4110", "type": "HCPCS"}, {"code": "4028570", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 148.14, "maximum": 148.14, "gross_charge": 426.0, "discounted_cash": 319.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE", "code_information": [{"code": "80188", "type": "CPT"}, {"code": "7250188", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.93, "gross_charge": 307.0, "discounted_cash": 230.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309824", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE 250MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309824", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309820", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309820", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 270.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 186.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF 1ST 30", "code_information": [{"code": "99426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 77.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF EA ADDL", "code_information": [{"code": "99427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 63.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRIVATE DETOXIFICATION", "code_information": [{"code": "1990086", "type": "CDM"}, {"code": "116", "type": "RC"}], "standard_charges": [{"gross_charge": 5704.0, "discounted_cash": 4278.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE DETOXIFICATION", "code_information": [{"code": "2430086", "type": "CDM"}, {"code": "116", "type": "RC"}], "standard_charges": [{"gross_charge": 5704.0, "discounted_cash": 4278.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "1990052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 4798.0, "discounted_cash": 3598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE PSYCHIATRIC", "code_information": [{"code": "2430052", "type": "CDM"}, {"code": "114", "type": "RC"}], "standard_charges": [{"gross_charge": 4798.0, "discounted_cash": 3598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE REHABILITATION", "code_information": [{"code": "1990065", "type": "CDM"}, {"code": "118", "type": "RC"}], "standard_charges": [{"gross_charge": 6549.0, "discounted_cash": 4911.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE REHABILITATION", "code_information": [{"code": "2700065", "type": "CDM"}, {"code": "118", "type": "RC"}], "standard_charges": [{"gross_charge": 6549.0, "discounted_cash": 4911.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "1990001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2010001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2050001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2150001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2160001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2180001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2300001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRIVATE ROOM", "code_information": [{"code": "2320001", "type": "CDM"}, {"code": "111", "type": "RC"}], "standard_charges": [{"gross_charge": 6750.0, "discounted_cash": 5062.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PRO-INSULIN", "code_information": [{"code": "84206", "type": "CPT"}, {"code": "7253526", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.24, "gross_charge": 711.0, "discounted_cash": 533.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.6, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROBE CRYOABLATION", "code_information": [{"code": "C2618", "type": "HCPCS"}, {"code": "8240355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23182.0, "discounted_cash": 17386.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE CRYOABLATION 2", "code_information": [{"code": "C2618", "type": "HCPCS"}, {"code": "8240353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22060.0, "discounted_cash": 16545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 464.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68811", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 806.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NL DUCT W/BALLOON", "code_information": [{"code": "68816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 569.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 719.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 975.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 719.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE TISSUE ABLATION", "code_information": [{"code": "C1886", "type": "HCPCS"}, {"code": "8176163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 962.5, "discounted_cash": 721.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBENECID 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309847", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee 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"standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.59, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.5, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 103.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN", "code_information": [{"code": "84145", "type": "CPT"}, {"code": "4178374", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 103.25, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60.47, "methodology": "fee 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{"description": "PROCARBAZINE, ORAL", "code_information": [{"code": "S0182", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.24, "maximum": 139.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 139.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCENTA, PER 200 MG", "code_information": [{"code": "Q4244", "type": "HCPCS"}], "standard_charges": [{"minimum": 39751.63, "maximum": 39751.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39751.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0780", "type": "HCPCS"}, {"code": "5323720", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 13.01, "maximum": 13.01, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0780", "type": "HCPCS"}, {"code": "5323720", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 13.01, "maximum": 13.01, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309983", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309983", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 25MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338613", "type": 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"maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309979", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5309979", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE MALEATE 5MG", "code_information": [{"code": "Q0164", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.68, "maximum": 1.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY ABLATE", "code_information": [{"code": "45320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE 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schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 123.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 402.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DILATE", "code_information": [{"code": "45303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 310.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 889.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1085.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 889.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY DX", "code_information": [{"code": "45300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 174.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 156.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY FB", "code_information": [{"code": "45307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 363.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 118.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 255.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 118.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 243.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45309", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 324.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY REMOVAL", "code_information": [{"code": "45315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 127.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 272.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 127.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 374.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/BX", "code_information": [{"code": "45305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 113.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 215.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 113.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 422.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROG STIM/PACNG AFTER IV DRUG", "code_information": [{"code": "93799", "type": "CPT"}, {"code": "4613806", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3.79, "gross_charge": 13640.0, "discounted_cash": 10230.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROG/EVAL PERIPROC PM OR LDLES", "code_information": [{"code": "93286", "type": "CPT"}, {"code": "4612986", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.29, "gross_charge": 1080.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROG/EVAL SNGL LD OR LDLES PM", "code_information": [{"code": "93279", "type": "CPT"}, {"code": "4613279", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.02, "gross_charge": 311.0, "discounted_cash": 233.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGENAMATRIX, PER SQ CM", "code_information": [{"code": "Q4222", "type": "HCPCS"}], "standard_charges": [{"minimum": 345.47, "maximum": 345.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 345.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE", "code_information": [{"code": "84144", "type": "CPT"}, {"code": "7254144", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.12, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 40.52, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310030", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE 100MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310030", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310032", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE 200MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310032", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGRAM INTAKE ASSESSMENT", "code_information": [{"code": "T1023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER PATIENT INSPIRE", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8176158", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 17245.0, "discounted_cash": 12933.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT NEUROSTIM", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8240357", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 13189.0, "discounted_cash": 9891.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT NSTIM 2", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8242820", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4877.0, "discounted_cash": 3657.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRMR PT NSTIM PRODIGY MRI", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "8176157", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PROLACT+6 HMF 15ML", "code_information": [{"code": "8030900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 992.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PROLACT+6 HMF 30ML", "code_information": [{"code": "8030897", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 1179.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}, {"code": "7254146", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.51, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.64, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC 1ST HR", "code_information": [{"code": "99415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG CLIN STAFF SVC EA ADD", "code_information": [{"code": "99416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 34.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG IP/OBS E/M EA 15 MIN", "code_information": [{"code": "99418", "type": "CPT"}], "standard_charges": [{"minimum": 143.45, "maximum": 143.45, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROLNG OP E/M EACH 15 MIN", "code_information": [{"code": "99417", "type": "CPT"}], "standard_charges": [{"minimum": 109.05, "maximum": 109.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 109.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG HOME EVAL ADD 15M", "code_information": [{"code": "G0318", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.96, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 37.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG INPT EVAL ADD15 M", "code_information": [{"code": "G0316", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.76, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG NURSIN FAC EVAL 15M", "code_information": [{"code": "G0317", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.35, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG OUTPT/OFFICE VIS", "code_information": [{"code": "G2212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 113.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, ADDL 30M", "code_information": [{"code": "G0514", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 216.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 216.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG PREV SVCS, FIRST 30M", "code_information": [{"code": "G0513", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 215.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERV W/O CONTACT ADD", "code_information": [{"code": "99359", "type": "CPT"}], "standard_charges": [{"minimum": 133.55, "maximum": 133.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONG SERVICE W/O CONTACT", "code_information": [{"code": "99358", "type": "CPT"}], "standard_charges": [{"minimum": 319.98, "maximum": 319.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 319.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLOTHERAPY", "code_information": [{"code": "M0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMAZINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2950", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.94, "maximum": 3.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZ 6.25MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316155", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZ 6.25MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316155", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZIN/COD 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316147", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZIN/COD 5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316147", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338634", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338634", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310065", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 12.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310065", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338638", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338638", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 58.0, "discounted_cash": 43.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310068", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 50MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338642", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE 50MG SU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338642", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE HCL 12.5MG ORAL", "code_information": [{"code": "Q0169", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE UPTO50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}, {"code": "5323798", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 13.62, "maximum": 13.62, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE UPTO50MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}, {"code": "5323798", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 13.62, "maximum": 13.62, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPAFENONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310090", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPAFENONE 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310090", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPAFENONE 225MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310093", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPAFENONE 225MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310093", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 77.0, "discounted_cash": 57.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPANTHELINE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPANTHELINE 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310138", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPARACAINE .5% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332242", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT CRTX DTHRM", "code_information": [{"code": "67141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 785.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 323.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT PC", "code_information": [{"code": "67145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 785.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 292.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPOFOL PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2704", "type": "HCPCS"}, {"code": "5323852", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.49, "maximum": 0.49, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPOFOL PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2704", "type": "HCPCS"}, {"code": "5323852", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.49, "maximum": 0.49, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPOXYPHENE QNT", "code_information": [{"code": "80367", "type": "CPT"}, {"code": "7253953", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310199", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310199", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310201", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316172", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 20MG/5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316172", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310203", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310203", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPRANOLOL 60MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310208", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, 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"gross_charge": 10901.0, "discounted_cash": 8175.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS TOE HINGE", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "8134500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1574.02, "maximum": 1574.02, "gross_charge": 13541.0, "discounted_cash": 10155.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS TOE TYPE II", "code_information": [{"code": "L8641", "type": "HCPCS"}, {"code": "8134502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1574.02, "maximum": 1574.02, "gross_charge": 2076.0, "discounted_cash": 1557.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1574.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROS UR AMS SPHINCTER800", "code_information": [{"code": "C1815", "type": "HCPCS"}, {"code": "8242880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 63288.0, "discounted_cash": 47466.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTATE BIOPSY, ANY MTHD", "code_information": [{"code": "G0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 695.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 320.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 355.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 233.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE CA SCREENING; DRE", "code_information": [{"code": "G0102", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 85.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 85.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3002.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1006.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATE SATURATION SAMPLING", "code_information": [{"code": "55706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1371.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY (TURP)", "code_information": [{"code": "52601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 29411.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2648.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 887.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18985.15, "maximum": 40118.45, "estimated_discounted_cash": 147445.4, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25513.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20445.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19751.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18985.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31770.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 40118.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33874.38, "maximum": 71581.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 46016.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 36480.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35241.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33874.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56687.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71581.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12005.59, "maximum": 25369.59, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14117.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12929.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12490.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12005.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20090.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25369.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC MICROWAVE THERMOTX", "code_information": [{"code": "53850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12620.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11357.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12620.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1305.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1096.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1647.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1096.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOTX", "code_information": [{"code": "53852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12620.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11357.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12620.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1397.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1035.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1610.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1035.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6937.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS MODIFICATION", "code_information": [{"code": "D5875", "type": "HCPCS"}], "standard_charges": [{"minimum": 510.58, "maximum": 510.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 510.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC TRAING 1ST ENC", "code_information": [{"code": "97761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 152.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTHODONT HIGH NOBLE METAL", "code_information": [{"code": "D6210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1679.58, "maximum": 1679.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1679.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTAMINE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2720", "type": "HCPCS"}, {"code": "5323870", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6.29, "maximum": 6.29, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTAMINE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2720", "type": "HCPCS"}, {"code": "5323870", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.29, "maximum": 6.29, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTAMINE SULFATE PER 50 MG", "code_information": [{"code": "A4802", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.1, "maximum": 12.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTECTIVE RESTORATION", "code_information": [{"code": "D2940", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.99, "maximum": 126.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 44.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 26.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN C ACTIVITY", "code_information": [{"code": "85303", "type": "CPT"}, {"code": "7255303", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.5, "gross_charge": 385.0, "discounted_cash": 288.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"standard_charges": [{"minimum": 1.0, "maximum": 58.11, "gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELCTRO OTHER FLUIDS", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "4124166", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 67.63, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", 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"plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE 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"discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TREATMENT COMPLEX", "code_information": [{"code": "77525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5651.88, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1879.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5086.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5651.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4553.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT INTERMEDIATE", "code_information": [{"code": "77523", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5651.88, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1664.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5086.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5651.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4033.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/COMP", "code_information": [{"code": "77522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4320.57, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1449.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3888.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4320.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3512.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/O COMP", "code_information": [{"code": "77520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4320.57, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1449.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3888.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4320.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3512.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTOZOA AB NES", "code_information": [{"code": "86753", "type": "CPT"}, {"code": "7256755", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.0, "gross_charge": 374.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTRIPTYLINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTRIPTYLINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310239", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTRIPTYLINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310236", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTRIPTYLINE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310236", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROVIDE INR TEST MATER/EQUIP", "code_information": [{"code": "G0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 238.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 238.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 75.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT BLOCK >5 YR", "code_information": [{"code": "49507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 25579.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2145.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT REDUC >5 YR", "code_information": [{"code": "49505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 25091.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1910.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1635.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 547.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRT UXTR SEP ACS", "code_information": [{"code": "36837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1636.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10937.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ AV FSTL CRTJ UXTR 1 ACS", "code_information": [{"code": "36836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1266.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9209.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 622.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ NJX BIOD OSTEO MATRL FEM", "code_information": [{"code": "814T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}, {"code": "4612938", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ TCAT THER RX NTRAC BALLN", "code_information": [{"code": "4610913", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 28507.6, "discounted_cash": 21380.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PRQ TCAT THR RX NTR BLLN SEPRT", "code_information": [{"code": "4610914", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14253.8, "discounted_cash": 10690.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PRQ TCAT THRM ABLT NRV P-ART", "code_information": [{"code": "793T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE OLECRN PROCESS", "code_information": [{"code": "24147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2325.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 782.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2200.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 739.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 351.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}, {"code": "7254200", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.75, "gross_charge": 229.0, "discounted_cash": 171.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 73.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "4106316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.75, "gross_charge": 755.0, "discounted_cash": 566.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "4156316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.75, "gross_charge": 220.0, "discounted_cash": 165.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "4176316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.75, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA TOTAL", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "7256316", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 69.75, "gross_charge": 588.0, "discounted_cash": 441.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.72, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 19.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - 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TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 371.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 186.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 120MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310262", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 120MG XR TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310262", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 30MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310266", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 30MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310266", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 60MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PSEUDOEPHED 60MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PST TEF VCL CHD", "code_information": [{"code": "C1878", "type": "HCPCS"}, {"code": "8033761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6454.0, "discounted_cash": 4840.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"minimum": 172.85, "maximum": 172.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 172.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 30 MIN PT", "code_information": [{"code": "90832", "type": "CPT"}, {"code": "6400832", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 253.03, "gross_charge": 424.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 253.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSY THRPY 45MIN PT", "code_information": [{"code": "90834", "type": "CPT"}, {"code": "6400834", "type": "CDM"}, {"code": "914", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 334.54, "gross_charge": 424.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 334.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC ANXIETY DO MRNA 15 BMRK", "code_information": [{"code": "437U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 684.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"minimum": 317.56, "maximum": 1768.18, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 317.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 352.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1768.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"minimum": 910.17, "maximum": 5067.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 910.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1011.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5067.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_dollar": 910.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1011.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5067.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "411U", "type": "CPT"}], "standard_charges": [{"minimum": 910.17, "maximum": 5067.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 910.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1011.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5067.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOMIC ALYS PNL 26 GEN", "code_information": [{"code": "423U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 375.1, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 6656.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"minimum": 1195.53, "maximum": 6656.72, 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372.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MANUAL THRPY EA 15MIN", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "5700057", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 370.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MANUAL THRPY EA15MIN #2", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "5700058", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 494.0, "discounted_cash": 370.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MECH TRACTION BSC", "code_information": [{"code": "97012", "type": "CPT"}, {"code": "5700025", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 351.0, "setting": "both", "billing_class": "facility"}], 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1125.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 376.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 3784.16, "maximum": 20861.5, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3784.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4204.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20861.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4950.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 119.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 119.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS PREV CT", "code_information": [{"code": "807T", "type": "CPT"}], "standard_charges": [{"minimum": 145.43, "maximum": 325.55, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 292.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 325.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 145.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULM TISS VNTJ ALYS W/CT", "code_information": [{"code": "808T", "type": "CPT"}], "standard_charges": [{"minimum": 280.06, "maximum": 325.55, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 292.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 325.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 280.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13407.8, "maximum": 28332.66, "estimated_discounted_cash": 73464.95, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17680.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14439.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13948.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13407.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22437.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28332.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14907.68, "maximum": 31502.14, "estimated_discounted_cash": 98238.98, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22248.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16054.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15509.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14907.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24947.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31502.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8736.67, "maximum": 18461.87, "estimated_discounted_cash": 71601.13, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14088.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9408.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9089.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8736.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14620.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18461.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TST", "code_information": [{"code": "94618", "type": "CPT"}, {"code": "5504618", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.64, "gross_charge": 703.0, "discounted_cash": 527.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY STRESS TST", "code_information": [{"code": "94618", "type": "CPT"}, {"code": "6014618", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.64, "gross_charge": 810.0, "discounted_cash": 607.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULP CAP DIRECT", "code_information": [{"code": "D3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.93, "maximum": 125.93, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULP CAP INDIRECT", "code_information": [{"code": "D3120", "type": "HCPCS"}], "standard_charges": [{"minimum": 99.26, "maximum": 99.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULP VITALITY TEST", "code_information": [{"code": "D0460", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.46, "maximum": 71.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION COMPLETE", "code_information": [{"code": "D3357", "type": "HCPCS"}], "standard_charges": [{"minimum": 434.45, "maximum": 434.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INITIAL", "code_information": [{"code": "D3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 605.1, "maximum": 605.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 605.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INTERIM", "code_information": [{"code": "D3356", "type": "HCPCS"}], "standard_charges": [{"minimum": 434.45, "maximum": 434.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 434.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY ANTERIOR PRIM", "code_information": [{"code": "D3230", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.94, "maximum": 333.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 333.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY POSTERIOR PRI", "code_information": [{"code": "D3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 373.91, "maximum": 373.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 373.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OX SINGLE", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "5502205", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 9.52, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OXIM MULT DETRM", "code_information": [{"code": "94761", "type": "CPT"}, {"code": "5504761", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 14.38, "gross_charge": 828.0, "discounted_cash": 621.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OXIMTRY CONTINUOUS", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "5504762", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.87, "gross_charge": 1620.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "6901109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 764.0, "discounted_cash": 573.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "6901109", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 764.0, "discounted_cash": 573.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 71.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "6901104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1269.0, "discounted_cash": 951.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "6901104", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1269.0, "discounted_cash": 951.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 2240.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 169.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCT SHUNT TB/RESERV", "code_information": [{"code": "5201070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5593.0, "discounted_cash": 4194.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BREAST", "code_information": [{"code": "19000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 117.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR CYST BRST EA", "code_information": [{"code": "19001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 75.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 112.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURAPLY 1 SQ CM", "code_information": [{"code": "Q4195", "type": "HCPCS"}], "standard_charges": [{"minimum": 270.18, "maximum": 270.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024269", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 1342.0, "discounted_cash": 1006.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 2CMX2CM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024269", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 1342.0, "discounted_cash": 1006.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024634", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 862.0, "discounted_cash": 646.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 2CMX4CM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024634", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 862.0, "discounted_cash": 646.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 5X5 PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024267", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 5X5 PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024267", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 668.0, "discounted_cash": 501.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024264", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 843.0, "discounted_cash": 632.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM PER SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}, {"code": "4024264", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 393.6, "maximum": 393.6, "gross_charge": 843.0, "discounted_cash": 632.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURAPLY XT 1 SQ CM", "code_information": [{"code": "Q4197", "type": "HCPCS"}], "standard_charges": [{"minimum": 466.47, "maximum": 466.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 466.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURE TONE AUDIOMETRY AIR", "code_information": [{"code": "92552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 137.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 137.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 45.86, "maximum": 45.86, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY BG FBRGRFT BIOAC XSM 2CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4021050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4234.0, "discounted_cash": 3175.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BG FBRGRFT BIOACT MD 6CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4021049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13940.0, "discounted_cash": 10455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BG FIBERGRFT GPS BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25557.0, "discounted_cash": 19167.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY BG FIBERGRFT GPS BIO MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4028837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13940.0, "discounted_cash": 10455.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY DBM GRAFTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8134886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5491.0, "discounted_cash": 4118.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 85.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC CONT INFUSION", "code_information": [{"code": "64463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 282.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PX SUP FEE ANTI-CAN SUB PRES", "code_information": [{"code": "Q0512", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.69, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY COMPLICATED", "code_information": [{"code": "50135", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4062.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3567.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1195.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3447.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1156.4, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3745.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1256.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PYRAZINAMIDE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310295", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRAZINAMIDE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310295", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310297", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310297", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE10MG/2MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5323908", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE180MGXRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310301", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE180MGXRTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310301", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE60/5 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316217", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOSTIGMINE60/5 5MLLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316217", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PYRIDOXINE 25MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310324", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.7, "discounted_cash": 0.53, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOXINE 25MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310324", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 0.7, "discounted_cash": 0.53, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOXINE 50MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310328", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOXINE 50MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310328", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PYRIDOXINE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3415", "type": "HCPCS"}, {"code": "5323929", "type": "CDM"}, {"code": "250", "type": 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310376", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310376", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 80.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310370", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310370", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310374", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310374", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 123.0, "discounted_cash": 92.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310377", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310377", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 99.0, "discounted_cash": 74.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 50MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310368", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUETIAPINE 50MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310368", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINAPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310398", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINAPRIL 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310398", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINAPRIL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310400", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINAPRIL 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310400", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINIDINE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310447", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINIDINE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310447", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUININE 324MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310483", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUININE 324MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310483", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 56.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINUPRISTIN/DALFOPRISTIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2770", "type": "HCPCS"}], "standard_charges": [{"minimum": 1873.63, "maximum": 1873.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1873.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Qual nonmd est pt 11-20m", "code_information": [{"code": "G2062", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.98, "maximum": 80.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Qual nonmd est pt 21>min", "code_information": [{"code": "G2063", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.55, "maximum": 125.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Qual nonmd est pt 5-10m", "code_information": [{"code": "G2061", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.9, "maximum": 45.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7522", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANG HRT FLOW", "code_information": [{"code": "C7552", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1029.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 677.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&I HRT ART/VENT ANG DRG AD", "code_information": [{"code": "C7553", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT ANGIO W/FLOW RESRV", "code_information": [{"code": "C7528", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5954.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3419.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT GFT ANG W/FLOW RESRV", "code_information": [{"code": "C7529", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R-T PRS SENSING EDRL GDN SYS", "code_information": [{"code": "777T", "type": "CPT"}], "standard_charges": [{"minimum": 52.08, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT PER150U IJ", "code_information": [{"code": "90376", "type": "CPT"}, {"code": "5323979", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1819.57, "maximum": 1819.57, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1819.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT PER150U IJ", "code_information": [{"code": "90376", "type": "CPT"}, {"code": "5323979", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1819.57, "maximum": 1819.57, "gross_charge": 718.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1819.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUM 150IU IJ", "code_information": [{"code": "90377", "type": "CPT"}, {"code": "5323958", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 972.16, "maximum": 972.16, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 972.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUM 150IU IJ", "code_information": [{"code": "90377", "type": "CPT"}, {"code": "5323958", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 972.16, "maximum": 972.16, "gross_charge": 1196.0, "discounted_cash": 897.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 972.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC 150U IJ", "code_information": [{"code": "90375", "type": "CPT"}, {"code": "5323970", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "gross_charge": 1168.0, "discounted_cash": 876.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC 150U IJ", "code_information": [{"code": "90375", "type": "CPT"}, {"code": "5323970", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1099.89, "maximum": 1099.89, "gross_charge": 1168.0, "discounted_cash": 876.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 887.56, "maximum": 887.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 887.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM IJ", "code_information": [{"code": "90675", "type": "CPT"}, {"code": "5323974", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 1231.75, "maximum": 1231.75, "gross_charge": 4140.0, "discounted_cash": 3105.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1231.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM IJ", "code_information": [{"code": "90675", "type": "CPT"}, {"code": "5323974", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1231.75, "maximum": 1231.75, "gross_charge": 4140.0, "discounted_cash": 3105.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1231.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD EXC LESION UP TO 1.25 CM", "code_information": [{"code": "D7410", "type": "HCPCS"}], "standard_charges": [{"minimum": 556.7, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 556.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5622.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1888.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4824.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1620.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E <5CM", "code_information": [{"code": "24077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3746.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1254.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4829.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1623.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3841.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1298.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR < 3 CM", "code_information": [{"code": "26117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2740.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 925.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4899.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1645.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD SORCE SUPV HANDLG", "code_information": [{"code": "77790", "type": "CPT"}, {"code": "5207790", "type": "CDM"}, {"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 180.05, "gross_charge": 2543.0, "discounted_cash": 1907.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 67.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 71.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 162.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 180.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2303.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION APPLICATOR", "code_information": [{"code": "D5983", "type": "HCPCS"}], "standard_charges": [{"minimum": 1783.58, "maximum": 1783.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1783.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION CONE LOCATOR", "code_information": [{"code": "D5985", "type": "HCPCS"}], "standard_charges": [{"minimum": 2915.03, "maximum": 2915.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2915.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 322.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 264.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 127.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 244.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 271.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 322.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 110.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 567.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 350.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 193.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 510.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 567.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 523.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION SHIELD", "code_information": [{"code": "D5984", "type": "HCPCS"}], "standard_charges": [{"minimum": 1783.58, "maximum": 1783.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1783.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 191.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 51.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 171.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 191.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 122.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 503.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 239.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 168.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 453.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 503.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 393.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 369.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 180.31, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 125.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 332.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 369.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 86.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, 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"HUMANA COMMERCIAL", "standard_charge_dollar": 633.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 626.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 626.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 202.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 832.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 832.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 834.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 834.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 837.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 837.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6014", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 831.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 831.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX DELIVERY IMRT", "code_information": [{"code": "G6015", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1292.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1292.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 990.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 458.17, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 307.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 891.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 990.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 696.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 236.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3814.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1273.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF ELBOW", "code_information": [{"code": "24149", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4335.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1456.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIO/SURGICAL IMPLANT INDEX", "code_information": [{"code": "D6190", "type": "HCPCS"}], "standard_charges": [{"minimum": 331.51, "maximum": 331.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 331.51, "methodology": "fee schedule"}], 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"both", "billing_class": "facility"}]}, {"description": "RD SPINAL 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1952.0, "discounted_cash": 1464.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RD SPINAL 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5163.0, "discounted_cash": 3872.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RD TITANM/CRSSLNK NEON3 ULRICH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1808.0, "discounted_cash": 1356.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RD TYPE I", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4648.0, "discounted_cash": 3486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RD TYPE II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 771.0, "discounted_cash": 578.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RE-CEMENT OR RE-BOND CROWN", "code_information": [{"code": "D2920", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.99, "maximum": 126.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EVAL,EST PT,PROBLEM FOCUS", "code_information": [{"code": "D0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.72, "maximum": 80.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORATION OF CHEST", "code_information": [{"code": "32120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3133.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1052.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 33972.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4739.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1587.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3464.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1164.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3521.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1181.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3456.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1174.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF LOWER LEG", "code_information": [{"code": "27712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4034.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1355.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF TENDONS", "code_information": [{"code": "26437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2459.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 816.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4721.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1585.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REATTACH TOOTH FRAGMENT", "code_information": [{"code": "D2921", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.22, "maximum": 168.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBOUND MATRIX, PER SQ CM", "code_information": [{"code": "Q4296", "type": "HCPCS"}], "standard_charges": [{"minimum": 8704.94, "maximum": 8704.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8704.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3961.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1310.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3857.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1276.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5146.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1711.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5125.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1703.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4082.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1355.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5698.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1893.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT CAST OR PREFAB POST", "code_information": [{"code": "D2915", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.6, "maximum": 135.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEMENT INLAY ONLAY OR PART", "code_information": [{"code": "D2910", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.99, "maximum": 126.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 126.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP CROWN", "code_information": [{"code": "D6092", "type": "HCPCS"}], "standard_charges": [{"minimum": 193.63, "maximum": 193.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP PART DENTURE", "code_information": [{"code": "D6093", "type": "HCPCS"}], "standard_charges": [{"minimum": 210.47, "maximum": 210.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 210.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEMENT/BOND PART DENTURE", "code_information": [{"code": "D6930", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.22, "maximum": 168.22, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 168.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEPT ASSAY NON-ENDOCRN", "code_information": [{"code": "84238", "type": "CPT"}, {"code": "7253557", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 138.71, "gross_charge": 485.0, "discounted_cash": 363.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 71.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEPT ASSAY NON-ENDOCRN/2", "code_information": [{"code": "84238", "type": "CPT"}, {"code": "7254451", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 138.71, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 71.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECEPT ASSAY NON-ENDOCRN/3", "code_information": [{"code": "84238", "type": "CPT"}, {"code": "7254452", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 138.71, "gross_charge": 532.0, "discounted_cash": 399.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 71.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 82.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 42.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3993.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1331.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3950.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1315.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4330.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1445.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4507.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1502.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4335.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1441.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1564.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 523.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5503.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5503.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1841.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3184.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1073.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5140.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5140.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1707.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4903.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4903.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1623.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4542.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4542.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1518.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3634.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1212.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5381.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5381.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1796.7, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5736.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5736.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1916.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2881.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 960.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3451.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1150.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECON, CTA FOR SURG PLAN", "code_information": [{"code": "G0288", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 157.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 157.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 56.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/FIXATION", "code_information": [{"code": "21196", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5198.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5198.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1741.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5171.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5171.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1737.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4866.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1630.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O GRAFT", "code_information": [{"code": "21193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4473.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1503.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3677.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1235.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3696.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1243.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3521.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1181.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4992.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1668.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4028.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1353.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3375.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1132.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3510.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1177.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3917.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1315.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2564.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 860.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2114.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3573.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1205.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7662.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7662.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2574.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8333.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8333.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2799.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8962.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3009.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3315.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1113.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3691.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1241.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3883.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1304.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW LAT LIGMNT", "code_information": [{"code": "24344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4055.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1363.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW MED LIGMNT", "code_information": [{"code": "24346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4055.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1363.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5515.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1851.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6156.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2067.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3831.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1288.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2709.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 30819.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2945.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2367.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2508.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 845.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4771.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1676.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10688.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10688.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3555.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2025.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 675.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2309.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 771.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5740.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1928.54, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4854.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1626.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MAXILLA SEGMENT", "code_information": [{"code": "D7947", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 13903.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13903.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE NO GRAFT", "code_information": [{"code": "D7948", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 15572.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15572.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE W/GRAFT", "code_information": [{"code": "D7949", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 22691.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22691.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7703.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2567.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8004.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2684.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4373.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1467.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHOULDER JOINT", "code_information": [{"code": "23472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 26181.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5261.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1765.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ULNA/RADIOULNAR", "code_information": [{"code": "25337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3275.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1103.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT UPPER JAW BONE", "code_information": [{"code": "21206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3536.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1197.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 1", "code_information": [{"code": "53420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3055.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1024.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 2", "code_information": [{"code": "53425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3397.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1139.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4177.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1400.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5508.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5508.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1840.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4375.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1462.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5239.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1750.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3442.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1157.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2979.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2895.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25444", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3027.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1025.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2657.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 894.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4058.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1366.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2611.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 876.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4097.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1377.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27429", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4618.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MAXILLA TOTAL", "code_information": [{"code": "D7946", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 13903.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13903.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2259.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 759.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5632.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5632.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1889.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1855.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 161.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 161.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1938.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 780.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2728.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3078.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1028.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2599.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 867.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67973", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3343.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3335.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1112.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67975", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2462.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 822.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4738.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1590.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4033.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1353.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3444.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 288.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1479.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 288.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3091.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1038.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2895.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1205.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 198.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4043.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1639.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 234.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3814.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1286.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3685.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1238.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6099.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1977.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3674.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1225.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5733.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1922.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2317.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 243.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1043.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 243.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2475.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 266.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1008.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 266.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3172.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 346.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1461.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 346.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4292.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 346.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1838.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 346.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4406.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 288.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1802.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 288.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 683.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 106.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 106.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4488.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1486.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5163.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1713.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5318.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1750.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4515.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1518.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3374.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1130.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3693.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1236.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2908.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 967.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3558.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1191.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1372.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3539.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1184.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2609.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 875.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2979.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 999.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3610.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1210.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2596.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 871.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2841.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 953.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3517.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1179.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3424.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1148.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6329.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2115.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TONGUE FOLD", "code_information": [{"code": "41520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 924.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 441.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 120.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECORDER EVENT CARDIAC", "code_information": [{"code": "C1764", "type": "HCPCS"}, {"code": "8240369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38048.0, "discounted_cash": 28536.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY EA ADD 15 MIN", "code_information": [{"code": "3603571", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY EA ADDL 15 MIN", "code_information": [{"code": "3223571", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1056.0, "discounted_cash": 792.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY INIT 30 MIN", "code_information": [{"code": "3223570", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 2566.0, "discounted_cash": 1924.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25419.9, "maximum": 53716.01, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36026.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27375.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26445.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25419.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 42539.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 53716.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39295.46, "maximum": 83037.13, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 68544.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42318.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40881.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39295.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65759.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 83037.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17776.13, "maximum": 37563.6, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23357.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19143.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18493.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17776.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29747.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37563.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1644.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1644.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 520.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15240.87, "maximum": 32206.22, "estimated_discounted_cash": 129842.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18690.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16413.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15855.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15240.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25504.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32206.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9965.22, "maximum": 21058.0, "estimated_discounted_cash": 64990.22, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11891.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10731.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10367.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9965.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16676.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21058.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS UNIT", "code_information": [{"code": "P9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 517.78, "maximum": 517.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 489.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 277.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 154.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 353.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 393.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 377.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 185.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 141.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 317.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 222.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 74.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 529.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 373.44, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 182.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 476.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 529.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 584.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 301.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 221.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 525.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 584.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 362.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12154.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12154.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4059.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1212.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 964.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1474.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 964.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3395.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1138.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCE TESTIS TORSION", "code_information": [{"code": "54600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1658.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCT COMPND FACIAL BONE FX", "code_information": [{"code": "D7780", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 13569.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13569.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCT SIMPLE FACIAL BONE FX", "code_information": [{"code": "D7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 10567.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10567.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FACIAL BONES", "code_information": [{"code": "21209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2216.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 959.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2741.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 923.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3333.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1121.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3964.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1330.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF RECTAL PROLAPSE", "code_information": [{"code": "45900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 775.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 260.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6172.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6172.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2067.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7154.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7154.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2393.8, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1362.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 457.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PORTABLE PUMP", "code_information": [{"code": "96521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 450.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 142.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFILL/MAINT PUMP/RESVR SYST", "code_information": [{"code": "96522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 427.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 427.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 135.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REFITTING OF OBTURATOR", "code_information": [{"code": "D5933", "type": "HCPCS"}], "standard_charges": [{"minimum": 1561.01, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1561.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGADENOSON PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2785", "type": "HCPCS"}, {"code": "5323992", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 54.16, "maximum": 54.16, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGADENOSON PER 0.1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2785", "type": "HCPCS"}, {"code": "5323992", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 54.16, "maximum": 54.16, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGIONAL BLOCK ANESTHESIA", "code_information": [{"code": "D9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.47, "maximum": 81.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2014.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 614.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1961.0, "maximum": 4037.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3133.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2058.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2040.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1961.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3197.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4037.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1961.0, "maximum": 4037.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3133.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2058.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2040.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1961.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3197.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4037.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4035.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1353.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3896.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1306.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4084.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1368.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4392.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1476.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7427.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2496.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3160.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1061.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE EYE WALL", "code_information": [{"code": "67250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3285.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1079.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3649.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1225.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE HUMERUS", "code_information": [{"code": "24498", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3183.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1065.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4305.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1440.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2653.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3331.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1118.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3721.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1250.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4129.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1386.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REINFORCE TIBIA", "code_information": [{"code": "27745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2740.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 905.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2725.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 916.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE/GRAFT EYE WALL", "code_information": [{"code": "67255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2499.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 830.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3386.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1133.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3514.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1158.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT SPINAL FIXATION", "code_information": [{"code": "22849", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4759.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1596.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1810.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 602.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2442.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 815.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4309.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1433.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6825.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2267.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7178.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2384.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FINGER CONTRACTURE", "code_information": [{"code": "26525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 60027.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2525.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOOT/TOE NERVE", "code_information": [{"code": "64726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 991.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 335.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOREARM/HAND TENDON", "code_information": [{"code": "26449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2593.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 873.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE HAND/FINGER TENDON", "code_information": [{"code": "26445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 10742.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2227.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 737.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6877.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2287.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE KNUCKLE CONTRACTURE", "code_information": [{"code": "26520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 16613.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2511.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 829.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2947.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 974.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MUSCLES OF HAND", "code_information": [{"code": "26593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2378.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 789.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF BIG TOE", "code_information": [{"code": "28240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1085.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 535.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EYE FLUID", "code_information": [{"code": "67015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2193.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 725.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT CONTRACTURE", "code_information": [{"code": "28270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1234.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 590.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1129.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 543.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10237.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 979.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 501.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1366.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1479.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 748.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDON", "code_information": [{"code": "27680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1555.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDONS", "code_information": [{"code": "27681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1874.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 631.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5727.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1917.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1990.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 194.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 878.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 194.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2462.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1090.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2574.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 868.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4397.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1474.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5439.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5439.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1822.93, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF TOE JOINT EACH", "code_information": [{"code": "28272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 928.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 462.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4386.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1470.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3719.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1239.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3225.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1082.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM & FINGER TENDON", "code_information": [{"code": "26442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3644.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1214.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1183.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 398.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1757.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 592.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2221.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 747.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26123", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 35400.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3095.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1042.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 969.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 325.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM/FINGER TENDON", "code_information": [{"code": "26440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2396.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SHOULDER JOINT", "code_information": [{"code": "23020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2543.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SPINAL CORD LUMBAR", "code_information": [{"code": "63200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5601.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1894.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELEASE THUMB CONTRACTURE", "code_information": [{"code": "26508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2498.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 826.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE WRIST/FOREARM TENDON", "code_information": [{"code": "25295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1956.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 658.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3993.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1338.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONTRACTURE", "code_information": [{"code": "52640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1185.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 399.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7442.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2491.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2988.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 986.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE PRESSURE ON NERVE(S)", "code_information": [{"code": "64722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1367.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 459.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1285.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1461.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 488.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATE SKIN PKT AICD", "code_information": [{"code": "4613223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10498.0, "discounted_cash": 7873.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2866.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 961.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1230.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 411.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM AICD LDS TRANSVEN", "code_information": [{"code": "4613243", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13653.0, "discounted_cash": 10239.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REM AICD PULS GEN", "code_information": [{"code": "4613241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12642.0, "discounted_cash": 9481.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN CAL SETUP", "code_information": [{"code": "740T", "type": "CPT"}], "standard_charges": [{"minimum": 66.83, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM AUTON ALG NSLN DATA COLL", "code_information": [{"code": "741T", "type": "CPT"}], "standard_charges": [{"minimum": 171.37, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 171.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ENDO VENA CAVA FILTR", "code_information": [{"code": "4917193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 42288.0, "discounted_cash": 31716.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 39440.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1227.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1182.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1729.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1182.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM EXOSTOSIS ANY SITE", "code_information": [{"code": "D7471", "type": "HCPCS"}], "standard_charges": [{"minimum": 945.03, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM IMP TOOTH W MUCOPER FLP", "code_information": [{"code": "D7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.3, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 130.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 280.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 92.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS PHYS", "code_information": [{"code": "578T", "type": "CPT"}], "standard_charges": [{"minimum": 136.66, "maximum": 136.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS TECH", "code_information": [{"code": "579T", "type": "CPT"}], "standard_charges": [{"minimum": 82.8, "maximum": 82.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 171.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 171.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 72.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 72.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR ALYS", "code_information": [{"code": "608T", "type": "CPT"}], "standard_charges": [{"minimum": 578.43, "maximum": 578.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 578.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR SETUP", "code_information": [{"code": "607T", "type": "CPT"}], "standard_charges": [{"minimum": 74.15, "maximum": 74.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 187.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 62.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST > 1.25 CM", "code_information": [{"code": "D7461", "type": "HCPCS"}], "standard_charges": [{"minimum": 1056.39, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1056.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST TO 1.25CM", "code_information": [{"code": "D7460", "type": "HCPCS"}], "standard_charges": [{"minimum": 744.19, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 744.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA DEV SETUP&EDUCAJ", "code_information": [{"code": "604T", "type": "CPT"}], "standard_charges": [{"minimum": 65.62, "maximum": 118.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 118.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA PHYS/QHP EA 30D", "code_information": [{"code": "606T", "type": "CPT"}], "standard_charges": [{"minimum": 28.96, "maximum": 94.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA TECHL SPRT MIN 8", "code_information": [{"code": "605T", "type": "CPT"}], "standard_charges": [{"minimum": 37.15, "maximum": 250.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST > 1.25 CM", "code_information": [{"code": "D7451", "type": "HCPCS"}], "standard_charges": [{"minimum": 978.86, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 978.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST TO 1.25CM", "code_information": [{"code": "D7450", "type": "HCPCS"}], "standard_charges": [{"minimum": 756.32, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 756.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM PCMKR PULS GEN ONLY", "code_information": [{"code": "4612503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 13658.0, "discounted_cash": 10243.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REM PCMKR TRAN ELCT DUAL", "code_information": [{"code": "4612500", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12186.0, "discounted_cash": 9139.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REM PERICTH OBST CV CATH", "code_information": [{"code": "4916536", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14476.0, "discounted_cash": 10857.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REM PERICTH OBST CV CATH", "code_information": [{"code": "75901", "type": "CPT"}, {"code": "4915901", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 745.67, "gross_charge": 23607.0, "discounted_cash": 17705.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 270.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 252.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 568.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 631.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charges": [{"minimum": 1.0, "maximum": 123.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 20MINS", "code_information": [{"code": "G9979", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 172.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 172.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30 MINS", "code_information": [{"code": "G9980", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 275.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 275.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 30MINS", "code_information": [{"code": "G9483", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 193.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 193.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9484", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 327.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 45MINS", "code_information": [{"code": "G9981", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 464.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 464.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 198.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9485", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 428.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOTE E/M NEW PT 60MINS", "code_information": [{"code": "G9982", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 618.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 618.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 257.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY LMBR/SAC", "code_information": [{"code": "63307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8751.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8751.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2929.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8939.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2993.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8421.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8421.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2818.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8787.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8787.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2949.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3741.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1254.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4623.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1550.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVABLE PROSTHODONTIC PROC", "code_information": [{"code": "D5899", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2548.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4691.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4691.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1576.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL ANTERIOR INSTRMJ", "code_information": [{"code": "22855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4045.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1355.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 343.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 406.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 406.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2303.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 553.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 698.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 967.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 698.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SKIN/AREOLAR TISS", "code_information": [{"code": "D7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 467.07, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 467.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 711.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1008.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 137.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 489.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 137.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 418.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 78.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 239.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 78.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 724.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 350.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1844.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1225.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [{"code": "20670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 531.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 219.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 423.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 219.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4388.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1440.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4629.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4629.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1551.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1911.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 642.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3731.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1251.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 788.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 264.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 856.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 286.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 735.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 907.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL FISSURE", "code_information": [{"code": "46200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 22318.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1244.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 141.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 579.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 141.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL TAGS", "code_information": [{"code": "46230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 635.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 377.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE BONE", "code_information": [{"code": "28130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2277.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 775.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2089.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE/HEEL LESION", "code_information": [{"code": "28100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1540.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 199.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 746.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 199.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANORECTAL LESION", "code_information": [{"code": "45108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1371.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 460.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2109.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 705.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3237.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1082.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3541.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1186.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2112.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 706.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4921.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4921.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1642.89, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3612.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1204.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5327.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5327.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1783.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6560.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2198.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7617.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2553.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2325.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 780.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2175.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 730.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3116.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1045.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2802.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 939.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1727.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 654.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 215.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 460.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 215.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 50041.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 996.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 332.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2058.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 691.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2567.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23146", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2309.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6977.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2340.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7965.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2666.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8030.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2688.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6835.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2282.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10080.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10080.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3370.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13489.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13489.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4521.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11533.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11533.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3844.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7592.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2541.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12122.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12122.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4052.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11142.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11142.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3727.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6032.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2020.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9365.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3134.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8918.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8918.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2984.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9653.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9653.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3229.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8584.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2873.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7923.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7923.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2650.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7913.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2649.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8152.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8152.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2727.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST LESION", "code_information": [{"code": "19120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1529.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 107.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 635.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 107.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BREAST TISSUE", "code_information": [{"code": "19300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1580.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 702.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 151.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BROW WRINKLES", "code_information": [{"code": "15826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3315.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CALCIUM DEPOSITS", "code_information": [{"code": "23000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1326.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 200.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 675.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 200.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX", "code_information": [{"code": "57530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1378.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 458.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6642.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2206.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3295.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1103.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2096.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3332.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1112.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLLAR BONE", "code_information": [{"code": "23125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2619.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 880.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6686.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2238.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4493.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4493.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1505.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7758.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2593.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7459.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2493.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8292.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2772.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1535.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 515.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2079.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3048.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1016.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10645.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3553.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15782.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15782.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5269.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15446.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15446.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5159.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13555.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13555.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4528.7, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2900.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 968.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5251.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5251.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1755.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2297.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 758.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2859.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 946.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3448.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1141.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1422.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 471.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3097.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1017.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4797.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1586.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2186.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 836.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1382.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 643.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 166.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1736.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 200.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 801.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 200.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8673.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8673.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FALLOPIAN TUBE", "code_information": [{"code": "58700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2932.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 978.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1473.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 493.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1827.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 122.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 122.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB REACTION", "code_information": [{"code": "D7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 945.03, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER LESION", "code_information": [{"code": "26210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1670.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 562.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER TENDON", "code_information": [{"code": "26180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 17839.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FASCIA", "code_information": [{"code": "28062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1491.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 710.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4031.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 487.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 112.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 112.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28192", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1143.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 152.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 152.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28193", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1347.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 619.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28072", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1201.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 594.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1398.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 158.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 653.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 158.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1140.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 162.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 162.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT LESION", "code_information": [{"code": "28104", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1308.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 641.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREARM LESION", "code_information": [{"code": "25120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1864.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREHEAD WRINKLES", "code_information": [{"code": "15824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4081.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 542.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 73.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "20525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 18515.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 903.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 226.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 226.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "27372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1475.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3995.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1322.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4281.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1417.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4431.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1466.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4565.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1511.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4314.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1428.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4108.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1363.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3884.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1303.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4089.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1370.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4523.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1523.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4609.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1542.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4974.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1665.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1145.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 162.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 162.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2753.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 926.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7423.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2483.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4856.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1627.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9304.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9304.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3121.71, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL BONE", "code_information": [{"code": "28118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1559.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 738.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL SPUR", "code_information": [{"code": "28119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 20967.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1346.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 637.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEMORRHOID CLOT", "code_information": [{"code": "46320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 416.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 104.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 256.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 104.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2538.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 853.4, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3043.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1020.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5793.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1946.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2464.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 828.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2936.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 987.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2506.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 844.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 34908.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1242.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 416.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELE", "code_information": [{"code": "55500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1435.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 480.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HYDROCELES", "code_information": [{"code": "55041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1873.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPACTED WAX MD", "code_information": [{"code": "G0268", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 63.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT DEEP", "code_information": [{"code": "20680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 46327.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1541.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 188.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 728.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 188.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT FROM HAND", "code_information": [{"code": "26320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1301.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 438.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1151.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 386.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE FLUID", "code_information": [{"code": "67036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 25442.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3243.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1078.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1746.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 639.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30117", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1517.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 600.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1158.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 600.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30118", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2603.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 858.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3944.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1307.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1556.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2056.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2075.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 690.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1730.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW BONE LESION", "code_information": [{"code": "21044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3154.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1056.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW JOINT", "code_information": [{"code": "21050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3149.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1056.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3502.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1177.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4708.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1579.33, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5298.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1775.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3435.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1152.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3268.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1095.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2387.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 803.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2183.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 734.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CYST", "code_information": [{"code": "27345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1804.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 609.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE PROSTHESIS", "code_information": [{"code": "27488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 17813.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4385.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1472.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP", "code_information": [{"code": "27350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2417.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 812.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP BURSA", "code_information": [{"code": "27340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1398.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 470.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7492.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2496.41, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9238.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9238.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3082.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10190.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10190.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3392.24, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4570.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1520.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 471.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 579.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3356.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1120.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2072.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 692.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS LESION", "code_information": [{"code": "66830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2570.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 855.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2509.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 834.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2854.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 949.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LENS MATERIAL", "code_information": [{"code": "66852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3035.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1009.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12556.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4194.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6166.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6166.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2060.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3551.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1189.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3650.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2950.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 988.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4903.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1640.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5297.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1771.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL", "code_information": [{"code": "28140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1563.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 687.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL HEADS", "code_information": [{"code": "28114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3077.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 235.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1303.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 235.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "6900034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4409.0, "discounted_cash": 3306.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "6900034", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 4409.0, "discounted_cash": 3306.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL BED", "code_information": [{"code": "11750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 3766.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 194.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NAIL PLATE", "code_information": [{"code": "11730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1608.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 195.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 64.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NECK WRINKLES", "code_information": [{"code": "15825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4592.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3109.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1049.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3927.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1318.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE", "code_information": [{"code": "30160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2992.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 988.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30124", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1123.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2405.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 791.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 299.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1712.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 566.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT", "code_information": [{"code": "65175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2838.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 933.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OMENTUM", "code_information": [{"code": "49255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2889.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 969.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARIAN CYST(S)", "code_information": [{"code": "58925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2808.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 938.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2036.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 678.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4398.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1466.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY/TUBE(S)", "code_information": [{"code": "58720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2785.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 928.27, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1726.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PALM TENDON EACH", "code_information": [{"code": "26170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1522.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 511.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6584.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2203.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4036.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1352.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4534.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4534.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1518.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4279.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1434.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8301.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2780.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10664.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3575.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PENIS", "code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2993.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1010.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8397.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2810.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5716.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1912.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 836.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3975.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1333.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3049.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1022.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3125.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1047.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTAL MARKER", "code_information": [{"code": "46030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 314.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 175.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6562.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2191.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6553.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2192.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5793.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5793.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1941.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6321.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6321.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2116.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2898.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 963.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1589.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2253.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 756.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2573.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 861.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4863.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1758.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 608.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 284.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 970.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1272.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 643.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM", "code_information": [{"code": "55150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1805.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM LESION", "code_information": [{"code": "55120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1305.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 438.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SESAMOID BONE", "code_information": [{"code": "28315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1203.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 581.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1659.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 556.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN WRINKLES", "code_information": [{"code": "15829", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9692.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKULL LESION", "code_information": [{"code": "61500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5496.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4748.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1583.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SLOUGHED OFF BONE", "code_information": [{"code": "D7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 778.06, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 778.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4419.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1481.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 863.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 288.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4255.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1426.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM CORD LESION", "code_information": [{"code": "55520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPERM DUCT(S)", "code_information": [{"code": "55250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 843.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 405.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 110.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2254.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 756.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4210.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1411.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4161.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1394.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 315.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7158.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7158.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2397.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8205.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2750.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8334.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2789.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5248.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5248.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1761.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7351.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7351.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2463.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2330.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7669.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7669.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2567.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 135.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURE FROM ANUS", "code_information": [{"code": "46754", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 890.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 111.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 424.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 111.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURES", "code_information": [{"code": "S0630", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE", "code_information": [{"code": "27080", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1870.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2304.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 778.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2912.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 979.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", "code_information": [{"code": "68500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3856.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1277.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2681.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 889.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON FOR GRAFT", "code_information": [{"code": "20924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1857.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON LESION", "code_information": [{"code": "27630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1322.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 658.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 13138.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1203.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1862.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3808.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1275.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4038.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1353.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4886.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1636.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 41087.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3341.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1118.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4802.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1604.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4952.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1652.8, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3840.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1285.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TMJ CONDYLE", "code_information": [{"code": "D7840", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 9566.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9566.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE", "code_information": [{"code": "28150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1032.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 506.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 142.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28092", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1008.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 511.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIONS", "code_information": [{"code": "28108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20423.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1066.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7907.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2630.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 992.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 333.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 316.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TORUS PALATINUS", "code_information": [{"code": "D7472", "type": "HCPCS"}], "standard_charges": [{"minimum": 1167.75, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1167.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6572.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2190.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7332.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2442.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3769.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1262.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4142.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1388.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3425.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1149.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3278.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1099.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3240.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1086.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2130.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2825.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 954.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3363.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1129.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1451.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 488.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 676.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 261.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2226.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 746.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2314.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5327.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5327.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1582.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2464.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 823.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5077.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5077.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1695.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3820.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1276.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2042.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 682.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONE", "code_information": [{"code": "25210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 30129.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1834.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 617.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BONES", "code_information": [{"code": "25215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2294.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 772.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST LESION", "code_information": [{"code": "25130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1681.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 567.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1981.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2654.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2269.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 759.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2581.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 866.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVAL PERC R HRT VAD VENOUS", "code_information": [{"code": "4613988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22154.0, "discounted_cash": 16615.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVAL PROSTH RADIAL HEAD", "code_information": [{"code": "24164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2670.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 898.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 413.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR&STAPL XREQ ANES", "code_information": [{"code": "15854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPL XREQ ANES", "code_information": [{"code": "15853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 13.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPLE REQ ANES", "code_information": [{"code": "15851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 237.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36589", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7699.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 198.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV CATH", "code_information": [{"code": "36590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10371.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 682.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 268.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 79.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 297.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 44.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 154.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 44.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2083.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 701.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1850.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 622.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6916.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2315.24, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3824.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1286.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 956.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1555.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 690.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST COMPLEX", "code_information": [{"code": "46280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1762.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 592.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST INTER", "code_information": [{"code": "46275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1551.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 689.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST SUBQ", "code_information": [{"code": "46270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 17903.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1471.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 137.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 653.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 137.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11919.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11919.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3972.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2112.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 705.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2281.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 757.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4435.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1484.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4777.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1599.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4554.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1524.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 119.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2560.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 858.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3214.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1078.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BILI DRAIN CATH", "code_information": [{"code": "4917537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6234.0, "discounted_cash": 4675.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52317", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 18613.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1243.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 566.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 566.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1699.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 569.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8501.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2855.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6852.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2297.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6968.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2337.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7889.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2644.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2327.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 772.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 289.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 98.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 388.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 128.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY SHUNT", "code_information": [{"code": "62256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2256.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 753.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3695.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1238.91, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9281.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3106.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10681.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10681.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3579.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7642.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7642.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2559.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3909.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4912.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1625.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5830.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1944.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1761.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 592.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20912", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1775.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 483.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2157.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3052.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1014.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2271.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 754.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2093.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2435.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6892.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2307.4, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE CONTRACEPTIVE CAPSULE", "code_information": [{"code": "11976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 336.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 175.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2243.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 748.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 412.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 391.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 131.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 268.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 213.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 87.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 241.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 268.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DIGIT NERVE LESION", "code_information": [{"code": "64776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 23419.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1493.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 498.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 400.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 236.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT DEVICE", "code_information": [{"code": "11982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3302.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1094.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 948.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 479.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 252.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3887.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1291.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5793.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1927.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9237.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3076.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3075.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1026.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2805.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 941.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3008.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1008.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3403.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1135.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4910.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1640.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1367.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 458.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EPIDIDYMIS LESION", "code_information": [{"code": "54840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1181.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 396.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 374.22, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 374.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 998.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 464.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MAXILLA", "code_information": [{"code": "21032", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 955.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 457.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXT HEM GROUPS 2+", "code_information": [{"code": "46250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 27222.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1166.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 166.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 585.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 166.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTERNAL EAR PARTIAL", "code_information": [{"code": "69110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1203.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 484.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE SEGMENT", "code_information": [{"code": "22116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 505.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2011.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 803.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3268.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1087.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3591.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1189.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "66130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2044.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 844.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/ATTACH IMPLANT", "code_information": [{"code": "65105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3477.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3197.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1052.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5495.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1818.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5734.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1898.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID FOREIGN BODY", "code_information": [{"code": "67938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 427.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 311.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 370.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 157.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION", "code_information": [{"code": "67840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 569.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 129.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESION(S)", "code_information": [{"code": "67808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 445.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 475.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 198.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 591.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 246.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 538.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 282.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 393.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1499.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 661.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 147.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 542.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION", "code_information": [{"code": "27355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 36938.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2246.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 757.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/BURSA", "code_information": [{"code": "27062", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 25948.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1683.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 986.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 330.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2728.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 917.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3010.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1008.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2074.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 699.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1936.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM FOREIGN BODY", "code_information": [{"code": "25248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1575.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 520.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3101.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1042.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6828.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2284.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 34.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 149.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 73.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 182.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2658.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3556.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1179.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4002.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1325.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 489.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11030.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1221.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3047.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1020.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4751.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1595.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE HAND BONE LESION", "code_information": [{"code": "26200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2999.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1012.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES SUPER", "code_information": [{"code": "27065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1936.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 651.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 623.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 376.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 148.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2258.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 759.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2587.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 870.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3385.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1161.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3409.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3722.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1250.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5856.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1953.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2821.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 948.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2733.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 916.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 793.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 57.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9931.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 58.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2871.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 954.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GROUPS 2+", "code_information": [{"code": "46260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 23624.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1764.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 592.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP & FISS", "code_information": [{"code": "46257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1529.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 514.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP W/FISTU", "code_information": [{"code": "46258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1766.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS & FISS", "code_information": [{"code": "46261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1953.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 654.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS W/FIST", "code_information": [{"code": "46262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2141.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 721.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4135.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1386.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3367.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1113.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3627.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1202.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7760.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2579.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INT/EXT HEM 1 GROUP", "code_information": [{"code": "46255", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1299.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 632.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 172.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4279.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3180.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6308.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6308.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2104.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRAUTERINE DEVICE", "code_information": [{"code": "58301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1064.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1296.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1782.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1296.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IRIS AND LESION", "code_information": [{"code": "66600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3284.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1083.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2855.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 958.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5547.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5547.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1866.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3817.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1285.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE CYST", "code_information": [{"code": "27347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1955.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 657.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2532.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 852.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2821.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 947.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LAMINA/FACETS LUMBAR", "code_information": [{"code": "63012", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4363.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1462.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LIMB NERVE LESION", "code_information": [{"code": "64782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1676.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LOWER LEG BONE LESION", "code_information": [{"code": "27635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2136.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3196.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9249.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3094.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4875.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1633.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 566.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 221.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3603.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1205.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5602.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1875.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3602.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1208.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3459.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1145.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4491.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1492.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3635.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1224.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3060.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1010.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2665.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 894.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "6900032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "6900032", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "11732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 828.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 250.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 91.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 764.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1795.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 593.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NERVE LESION", "code_information": [{"code": "64784", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2652.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 895.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PALATE/LESION", "code_information": [{"code": "42120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3652.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 936.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4171.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1399.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3473.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1166.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3882.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1297.41, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9715.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9715.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3238.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3218.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1096.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4171.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1399.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2939.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 982.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4328.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1451.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5465.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1832.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PERC LEFT HEART VAD", "code_information": [{"code": "4613992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 22154.0, "discounted_cash": 16615.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 466.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST COMPL", "code_information": [{"code": "11772", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2118.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 200.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 933.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 200.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST EXTEN", "code_information": [{"code": "11771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 36971.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1647.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 760.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST SIMPLE", "code_information": [{"code": "11770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 22213.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 677.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5534.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1849.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1485.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 499.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1006.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 336.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 770.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 257.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 835.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 431.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6786.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2266.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 371.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 476.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 371.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2568.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3183.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1067.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1206.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4210.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1415.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3268.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1085.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3772.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1201.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3650.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1223.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1948.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 652.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2114.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 710.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2483.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BONE PART", "code_information": [{"code": "23130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2287.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1754.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 591.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FOREIGN BODY", "code_information": [{"code": "23330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 618.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2370.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SINGLE NAIL PLATE", "code_information": [{"code": "6900033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1065.0, "discounted_cash": 798.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE SINGLE NAIL PLATE", "code_information": [{"code": "6900033", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1065.0, "discounted_cash": 798.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1575.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN NERVE LESION", "code_information": [{"code": "64788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1506.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 504.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2618.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1273.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 427.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CANAL CATHETER", "code_information": [{"code": "62355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1013.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 344.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4005.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1344.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1205.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 372.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 820.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 372.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE ELTRD PLATE", "code_information": [{"code": "63662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3122.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1046.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2695.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATION DEVICE", "code_information": [{"code": "22852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2599.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 873.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE INFUSION DEVICE", "code_information": [{"code": "62365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1094.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 CRVL", "code_information": [{"code": "63001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4492.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1509.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 LMBR", "code_information": [{"code": "63005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4392.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1477.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 SCRL", "code_information": [{"code": "63011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3983.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1335.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 THRC", "code_information": [{"code": "63003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4509.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1516.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 CRVCL", "code_information": [{"code": "63015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5411.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1816.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 LMBR", "code_information": [{"code": "63017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4627.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA >2 THRC", "code_information": [{"code": "63016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5566.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1864.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 583.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 611.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 875.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 611.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4369.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1464.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3993.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1338.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2848.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 957.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2572.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 865.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2572.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 865.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3570.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1181.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4443.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1469.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TENDON SHEATH LESION", "code_information": [{"code": "26160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 28369.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1180.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 308.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 742.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 308.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2328.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 782.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3281.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1101.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3343.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1124.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3682.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1237.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4318.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1422.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4277.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1421.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 759.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1673.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 559.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2191.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID LESION", "code_information": [{"code": "60200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2447.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 818.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1075.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1122.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TORUS MANDIBULARIS", "code_information": [{"code": "D7473", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.26, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 802.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4429.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4429.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1488.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE TUNNELED IP CATH", "code_information": [{"code": "49422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 794.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UNILAT SPACE MAINTAIN", "code_information": [{"code": "D1520", "type": "HCPCS"}], "standard_charges": [{"minimum": 471.51, "maximum": 471.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 471.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2120.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 711.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 807.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 650.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 996.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 650.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URO SPHINCTER", "code_information": [{"code": "53446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2346.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 787.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1735.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 577.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3122.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1037.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA GLAND LESION", "code_information": [{"code": "56740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1155.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 383.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 636.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA LESION", "code_information": [{"code": "57135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 690.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 299.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6343.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6343.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2115.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5338.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1776.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3306.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1099.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1976.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 656.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 645.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 214.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2708.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 909.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1982.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 662.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1308.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 436.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILATING TUBE", "code_information": [{"code": "69424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 221.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 70.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3977.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1332.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4689.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1570.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN CRVL", "code_information": [{"code": "63081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6417.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2149.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63090", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7072.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2365.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8313.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8313.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2798.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63085", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7063.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2348.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8460.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8460.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2825.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8553.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2863.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9097.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3044.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY CRVCL", "code_information": [{"code": "63300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6600.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2220.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8040.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2587.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7944.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2659.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 955.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 687.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 930.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 310.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 630.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1054.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 352.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1152.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 383.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE W INSERT DRUG IMPLANT", "code_information": [{"code": "G0518", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 656.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 376.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3918.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1308.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5144.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1720.31, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT CARTILAGE", "code_information": [{"code": "25107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2293.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 774.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT IMPLANT", "code_information": [{"code": "25449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3786.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1273.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "25105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1811.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 610.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "26130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1747.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 587.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1291.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON LESION", "code_information": [{"code": "25111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 46433.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1216.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 410.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2795.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 942.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST/FOREARM LESION", "code_information": [{"code": "25116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2243.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 755.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1212.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT BONE LESION", "code_information": [{"code": "26205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2239.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 752.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FINGER LESION", "code_information": [{"code": "26215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2103.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 705.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2258.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 760.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1428.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 479.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1570.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 527.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 617.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2207.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 742.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2223.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 747.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3795.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1274.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27637", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2749.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 927.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27638", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2728.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 373.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 171.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPAIR HEARING AID", "code_information": [{"code": "69711", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3074.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1017.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3144.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1054.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2934.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 983.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REVISE MALE SLING", "code_information": [{"code": "53442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2866.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 962.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2786.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 934.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5425.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5425.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1816.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REMV TUNL CVC WO PMP/PRT", "code_information": [{"code": "4916589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV TUNL CVC WO PMP/PRT", "code_information": [{"code": "6296589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 24873.4, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1266.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 423.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1331.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2620.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3270.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1097.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMVE RENL TUBE W/FLUORO", "code_information": [{"code": "4914238", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5733.0, "discounted_cash": 4299.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 343.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3507.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3690.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1237.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL BIOPSY PERQ", "code_information": [{"code": "50200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4130.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 454.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 400.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 600.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 400.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2744.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9505.06, "maximum": 20085.6, "estimated_discounted_cash": 63640.36, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13858.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10236.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9888.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9505.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15906.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20085.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16073.29, "maximum": 33965.25, "estimated_discounted_cash": 80602.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22136.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17309.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16721.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16073.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26897.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33965.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6515.06, "maximum": 13767.28, "estimated_discounted_cash": 52169.88, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8865.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7016.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6777.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6515.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10902.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13767.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "4100069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.92, "gross_charge": 580.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "4120069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.92, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "4150069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.92, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FUNCTION PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "4170069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.92, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2082.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 697.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENIN", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "7258424", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.41, "gross_charge": 219.0, "discounted_cash": 164.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 793.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 256.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 297.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 137.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 152.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 793.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 188.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 85.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 99.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 45.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 166.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENIN/2", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "7250213", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 83.41, "gross_charge": 1032.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1059.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 352.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3774.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1264.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 533.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 178.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 558.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP NPH/URT CATH W/DIL STRIC", "code_information": [{"code": "C7546", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PARTIAL DENTURE CLASP", "code_information": [{"code": "D5630", "type": "HCPCS"}], "standard_charges": [{"minimum": 384.8, "maximum": 384.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2026.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 681.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4498.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4498.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1513.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAGLINIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310553", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAGLINIDE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310553", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 621.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 208.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ACHILLES TENDON", "code_information": [{"code": "27650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2421.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 815.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANAL FISTULA", "code_information": [{"code": "46288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2048.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 687.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6421.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2147.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1843.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 621.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARM/LEG NERVE", "code_information": [{"code": "64857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3836.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1282.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6115.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2043.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8082.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2698.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7633.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2553.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9162.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9162.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3058.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7824.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2553.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4495.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4495.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1400.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6678.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2229.33, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5120.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5120.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1714.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5773.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5773.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1928.54, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4029.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1345.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5773.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5773.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1928.54, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4664.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4664.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1556.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7284.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2432.93, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7303.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2437.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BICEPS TENDON", "code_information": [{"code": "23430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 15967.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2741.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2909.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 965.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER DEFECT", "code_information": [{"code": "57288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 25413.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2724.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 908.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2126.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 713.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2074.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 688.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2803.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 937.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2998.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1006.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL DIR LXTR", "code_information": [{"code": "4610056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8121.0, "discounted_cash": 6090.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2782.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 930.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6387.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6387.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2135.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3415.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1141.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4680.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1566.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5336.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5336.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1781.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35190", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2690.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 895.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3324.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1104.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2825.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2757.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 928.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4963.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1658.41, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7509.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7509.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2481.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5253.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5253.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1749.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2940.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 981.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4492.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1507.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3557.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1202.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5099.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1707.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5544.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1856.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6187.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6187.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2054.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3585.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1208.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3474.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1161.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3074.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1027.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4937.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1643.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5181.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1735.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5745.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5745.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1937.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3283.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1096.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5195.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5195.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1735.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3130.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1048.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3655.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5733.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5733.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1917.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4850.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4850.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1622.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5560.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5560.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1865.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5037.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5037.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1685.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5743.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1917.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 861.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR BROW DEFECT", "code_information": [{"code": "67900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1830.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 784.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6333.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2118.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2889.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3672.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1235.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4329.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1455.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3639.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1224.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3734.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1256.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3920.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1319.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4262.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1416.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2480.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 832.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARM ARTERY", "code_information": [{"code": "35045", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3440.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3973.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1311.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3528.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1179.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3581.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1192.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4479.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4479.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1500.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6114.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6114.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2038.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6279.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2098.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6648.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6648.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2213.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4698.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4698.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1569.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5584.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5584.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1865.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4885.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4885.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1635.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3861.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1288.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4390.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1460.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFORMITY OF TOE", "code_information": [{"code": "28313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 646.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEGENERATED KNEECAP", "code_information": [{"code": "27418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3022.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1009.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67107", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4056.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1350.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67108", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 34908.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4293.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1430.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA", "code_information": [{"code": "67110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2946.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1068.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA CRTX", "code_information": [{"code": "67101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1032.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DETACHED RETINA PC", "code_information": [{"code": "67105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 995.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 357.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3087.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1031.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2878.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6928.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2314.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7114.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2376.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4696.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1579.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5223.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1739.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69631", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3265.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1077.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4675.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW DEB/ATTCH OPEN", "code_information": [{"code": "24359", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2452.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 824.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW PERC", "code_information": [{"code": "24357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1546.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW W/DEB OPEN", "code_information": [{"code": "24358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1966.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 662.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4005.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1338.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5656.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1888.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3723.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1244.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5166.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5166.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1728.14, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3787.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1267.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9241.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9241.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3078.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR EXTRA TOE(S)", "code_information": [{"code": "28344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1032.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67901", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2135.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 217.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 217.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2627.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 875.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67903", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1739.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 131.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 725.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 131.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2156.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 889.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1827.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 610.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67908", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1567.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 650.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67914", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1196.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 728.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 121.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1557.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 729.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1653.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 746.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67921", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1136.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 728.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 112.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 112.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67923", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1559.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 729.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67924", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1653.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 203.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 852.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1585.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 722.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4246.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1408.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4525.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1500.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FIBULA NONUNION", "code_information": [{"code": "27726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3496.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1178.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5238.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1747.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2306.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 762.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2007.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2109.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 697.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2752.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26356", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2939.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 988.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26357", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3287.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1102.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 25420.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2882.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 957.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3237.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1073.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1872.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5311.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5311.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1779.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5562.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5562.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1863.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2439.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 207.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1029.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 207.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2606.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1107.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3050.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1021.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON SHEATH", "code_information": [{"code": "25275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2485.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 837.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2351.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2349.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 790.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2780.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 934.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1836.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 618.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2076.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 697.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2457.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 828.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7506.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2507.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7713.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2575.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6422.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2148.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6607.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2209.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6991.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2337.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6728.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2248.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8357.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2791.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8236.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2749.87, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8395.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2803.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8187.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2732.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1117.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 573.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5641.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1883.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT", "code_information": [{"code": "26540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2578.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3076.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1025.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT WITH GRAFT", "code_information": [{"code": "26542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 17199.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2662.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 885.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND TENDON", "code_information": [{"code": "26410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2218.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 733.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5830.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5830.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1948.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6579.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2200.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6708.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2241.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6678.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2229.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6455.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2157.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5539.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1855.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3969.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1330.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5886.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1967.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7140.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2386.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR HUMERUS WITH GRAFT", "code_information": [{"code": "24435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3965.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1331.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IMPLANT", "code_information": [{"code": "D6090", "type": "HCPCS"}], "standard_charges": [{"minimum": 939.03, "maximum": 939.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 939.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ING HERNIA SLIDING", "code_information": [{"code": "49525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 38471.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2093.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1891.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66682", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2586.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 800.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 688.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 70.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 308.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 70.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1181.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 397.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1361.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 455.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1393.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 465.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1262.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 634.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4937.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4937.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1651.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6769.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6769.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2265.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10836.07, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10836.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3631.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5248.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5248.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1721.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2429.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 816.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1829.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 615.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2245.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 754.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2447.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 823.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3377.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1140.24, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3819.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1277.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4982.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1654.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4224.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1416.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL DEFECTS", "code_information": [{"code": "D7955", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5004.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2966.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2975.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7111.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2376.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 531.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 273.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 733.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 362.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 98.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1410.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MULTI-COMP PENIS PROS", "code_information": [{"code": "54408", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2882.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 967.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MUSCLES OF HAND", "code_information": [{"code": "26591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1806.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 598.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTUM DEFECT", "code_information": [{"code": "30630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2457.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 811.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL STENOSIS", "code_information": [{"code": "30465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3764.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1243.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1196.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 400.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1304.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 437.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 703.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 235.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION CARPAL BONE", "code_information": [{"code": "25431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2901.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 975.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION HAND", "code_information": [{"code": "26546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3819.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1281.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2462.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 200.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1046.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 200.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3003.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1009.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ACHILLES TENDON", "code_information": [{"code": "27654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 9367.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2635.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 887.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2731.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2440.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 821.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4020.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1347.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3323.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1110.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2387.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 804.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2088.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1795.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27698", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 10483.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2345.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 788.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENTS", "code_information": [{"code": "27696", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2021.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 678.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7629.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2548.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5955.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1990.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM NERVES", "code_information": [{"code": "64861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5563.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1864.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1703.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 569.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2715.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 906.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3255.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1088.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 158.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 109.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL BULGE", "code_information": [{"code": "57268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1861.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 619.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4651.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4651.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1558.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2978.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 989.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CIRCUMCISION", "code_information": [{"code": "54163", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 804.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12773.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12773.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4282.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14064.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14064.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4713.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15235.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15235.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5104.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20640.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20640.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6889.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3134.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1043.23, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3366.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1132.72, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIGIT NERVE", "code_information": [{"code": "64831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2551.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 859.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1053.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 101.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 101.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EARDRUM", "code_information": [{"code": "69620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1818.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 258.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 899.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 258.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2303.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 770.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5298.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1771.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE SOCKET WOUND", "code_information": [{"code": "65290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1774.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 589.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 508.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 150.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 336.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 150.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1279.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 184.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 629.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 184.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1374.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 456.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1667.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2427.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 805.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3998.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1328.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1794.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 831.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 212.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3131.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1051.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3961.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1316.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1687.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 567.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT BONES", "code_information": [{"code": "28320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2269.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 760.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1206.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 599.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1186.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 584.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 12816.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1429.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 658.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 156.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 21485.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1100.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 149.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 149.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64834", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2731.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2990.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64836", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2990.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1004.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6991.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2333.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10838.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10838.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3626.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5524.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1848.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6242.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2086.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6797.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2271.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6935.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2316.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6928.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2314.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7298.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2438.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5521.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1847.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7282.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2433.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8670.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8670.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2904.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14513.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4839.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HUMERUS", "code_information": [{"code": "24430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3865.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1299.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HYDROCELE", "code_information": [{"code": "55060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1392.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 467.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9078.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3043.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4668.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1564.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE CARTILAGE", "code_information": [{"code": "27403", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2383.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 801.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2496.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 837.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENT", "code_information": [{"code": "27407", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2934.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 986.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENTS", "code_information": [{"code": "27409", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3545.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1191.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEECAP TENDON", "code_information": [{"code": "27380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 21485.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2300.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 768.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2611.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2862.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 962.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG NERVE", "code_information": [{"code": "64840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3516.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1182.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27658", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1366.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 460.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1745.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 585.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1340.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1568.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 517.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOW BACK NERVES", "code_information": [{"code": "64862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4991.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1676.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4450.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1495.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3804.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1277.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2720.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF METATARSALS", "code_information": [{"code": "28322", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2129.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 955.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 214.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9690.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3235.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8464.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8464.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2831.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8659.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2895.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "11760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 16194.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 400.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 223.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NASAL SEPTUM", "code_information": [{"code": "30520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 9905.38, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2480.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PENIS", "code_information": [{"code": "54440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2714.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PERINEUM", "code_information": [{"code": "56810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1002.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE", "code_information": [{"code": "45560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2523.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2079.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 699.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2201.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 738.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4668.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4668.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1564.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED TENDON", "code_information": [{"code": "24342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2848.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 957.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2924.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER", "code_information": [{"code": "23420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3576.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1202.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5188.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5188.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1713.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1828.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 612.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4814.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4814.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1612.52, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5252.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5252.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1760.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6109.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6109.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2046.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6772.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2267.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2439.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 817.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4926.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4926.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1651.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4318.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1448.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH MUSCLE", "code_information": [{"code": "27385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 39063.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2244.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3201.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1076.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2177.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 731.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TOE DISLOCATION", "code_information": [{"code": "28675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1530.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 698.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3066.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1028.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2836.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 33972.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 958.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2045.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1779.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 596.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1778.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 596.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2308.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 775.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2893.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 970.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1541.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1004.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 334.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "56800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 930.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 309.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "57200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1224.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2346.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 777.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3610.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1200.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5048.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1684.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4928.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1639.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6316.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6316.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2097.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4922.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1646.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15976.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1786.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 747.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2585.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 857.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2940.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 983.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3329.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1107.29, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 948.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 75.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 399.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 75.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2716.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 907.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE PHARYNX/UVULA", "code_information": [{"code": "42145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2526.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 841.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3393.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1128.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3046.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1019.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2535.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 844.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2909.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 976.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54385", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3386.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1134.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4501.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1509.41, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PERI-DEVICE LEAK", "code_information": [{"code": "4610030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 121999.0, "discounted_cash": 91499.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5906.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTHESIS PER 15 MIN", "code_information": [{"code": "L7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.48, "maximum": 179.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7216.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7216.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2410.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5213.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1743.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6435.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2151.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS & ULNA", "code_information": [{"code": "25415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3549.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1192.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS OR ULNA", "code_information": [{"code": "25400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2950.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 992.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4604.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4604.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1545.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4616.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4616.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1548.87, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM & VAGINA", "code_information": [{"code": "57250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2257.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 751.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2250.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 746.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3571.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1183.51, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5252.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5252.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1761.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4799.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1596.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF ACUTE", "code_information": [{"code": "23410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3011.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1012.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF CHRONIC", "code_information": [{"code": "23412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3130.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1051.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4940.23, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4940.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1651.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1272.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 548.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 109.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1689.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 701.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SCIATIC NERVE", "code_information": [{"code": "64858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4279.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1436.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33813", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4439.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5447.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1822.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5001.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1672.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6538.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2185.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3464.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1163.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3610.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1194.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3990.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1339.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3904.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1310.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4090.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1373.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23466", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4114.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1376.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7700.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2572.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9780.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9780.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3266.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7576.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2523.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63707", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3436.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1162.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID LEAKAGE", "code_information": [{"code": "63709", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4076.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1367.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4432.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5802.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2578.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5812.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5812.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1947.44, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6387.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2132.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1496.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 499.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TEAR DUCTS", "code_information": [{"code": "68700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2182.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 728.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TESTIS INJURY", "code_information": [{"code": "54670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1500.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 503.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3485.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1163.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1215.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 406.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TOE DISLOCATION", "code_information": [{"code": "28645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1798.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 562.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 343.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 670.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 135.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 763.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 395.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 123.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TOOTH SOCKET", "code_information": [{"code": "41874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 893.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 477.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 119.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 658.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 167.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 402.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 167.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2677.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 898.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17692.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17692.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5922.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4114.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1380.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2530.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 849.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 748.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1686.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 747.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1811.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 604.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2039.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 680.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2236.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4306.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1430.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA/PERINEUM", "code_information": [{"code": "57210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1446.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 479.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3177.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1063.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5470.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1829.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3892.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1302.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4106.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1372.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4414.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1474.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR WEBBED TOE(S)", "code_information": [{"code": "28345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1336.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 624.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1553.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 513.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 27222.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2608.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 865.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WRIST JOINTS", "code_information": [{"code": "25447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3068.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 992.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT ACHILLES TENDON", "code_information": [{"code": "27652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2473.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 824.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT EYE LESION", "code_information": [{"code": "66225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3389.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1126.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FEMUR HEAD/NECK", "code_information": [{"code": "27170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4265.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1434.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2736.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 904.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2932.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26434", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2564.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 850.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3060.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1015.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26358", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3621.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1214.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3362.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3676.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1219.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 21485.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2636.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 872.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT KNEECAP TENDON", "code_information": [{"code": "27381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3017.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1011.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4737.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1578.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1563.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 713.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 174.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4617.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1550.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH MUSCLE", "code_information": [{"code": "27386", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3149.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1055.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3286.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1104.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4570.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1533.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4264.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1432.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4106.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1378.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3798.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1278.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3533.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1186.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT WRIST BONE", "code_information": [{"code": "25440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2832.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 953.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/RELINE OCCLUSAL GUARD", "code_information": [{"code": "D9942", "type": "HCPCS"}], "standard_charges": [{"minimum": 232.06, "maximum": 232.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/REVISE WRIST JOINT", "code_information": [{"code": "25320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3651.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1230.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/SVC DME NON-OXYGEN EQ", "code_information": [{"code": "K0739", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.14, "maximum": 89.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR/TRANSPOSE NERVE", "code_information": [{"code": "64856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3669.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1235.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 481.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 255.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 455.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 255.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPEAT THYROID SURGERY", "code_information": [{"code": "60260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3963.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1325.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPL DUODEN TUBE W/FLUOR", "code_information": [{"code": "4919451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9176.0, "discounted_cash": 6882.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL GASTRO TUBE W/FLUOR", "code_information": [{"code": "4919450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7500.0, "discounted_cash": 5625.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL GJ TUBE W/FLUOR", "code_information": [{"code": "4919453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9176.0, "discounted_cash": 6882.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REPL SEMI/PRECISION ATTACH", "code_information": [{"code": "D6091", "type": "HCPCS"}], "standard_charges": [{"minimum": 739.29, "maximum": 739.29, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 739.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4664.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1560.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4840.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1615.81, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4819.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1612.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5043.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1683.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4280.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1429.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2149.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2605.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 871.1, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3439.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1149.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4077.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1359.97, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 220.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE DENTURE TEETH COMPLT", "code_information": [{"code": "D5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 208.2, "maximum": 208.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 315.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 562.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 562.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5283.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1774.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE EYE FLUID", "code_information": [{"code": "67025", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2285.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 116.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 887.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 116.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE G-J TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 485.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 654.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 654.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PERC", "code_information": [{"code": "49450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7239.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 233.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 544.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 544.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE PART DENTURE TEETH", "code_information": [{"code": "D5640", "type": "HCPCS"}], "standard_charges": [{"minimum": 312.2, "maximum": 312.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 312.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1002.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 881.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1568.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 881.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9771.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9771.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "4916581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7034.0, "discounted_cash": 5275.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 731.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 233.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 494.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 233.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 37349.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 655.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 606.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 889.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 606.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 36938.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1029.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 601.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1011.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 601.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1187.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1324.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4464.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1497.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8066.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8066.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2695.43, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6854.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2291.47, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2914.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 974.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1823.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 612.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1979.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 666.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/REVISE BRAIN SHUNT", "code_information": [{"code": "62230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3082.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1031.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8063.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2696.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10237.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3420.55, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9018.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9018.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3022.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT NASAL PROSTHESIS", "code_information": [{"code": "D5926", "type": "HCPCS"}], "standard_charges": [{"minimum": 5205.66, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5205.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11885.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11885.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3973.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11111.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11111.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3717.42, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11389.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11389.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3811.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF CONTACT LENS", "code_information": [{"code": "92326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 142.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 46.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9949.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9949.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3327.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF PRECISION ATT", "code_information": [{"code": "D5867", "type": "HCPCS"}], "standard_charges": [{"minimum": 395.69, "maximum": 395.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 395.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8243.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2752.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11814.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11814.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3964.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9953.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9953.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3340.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7451.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7451.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2500.67, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6447.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6447.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2163.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10101.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10101.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3389.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14244.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14244.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4778.85, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4844.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7466.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7466.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2505.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6617.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2222.16, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC MANDIBULAR", "code_information": [{"code": "D5671", "type": "HCPCS"}], "standard_charges": [{"minimum": 1551.34, "maximum": 1551.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1551.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC ON MTL FRMWK", "code_information": [{"code": "D5670", "type": "HCPCS"}], "standard_charges": [{"minimum": 1551.34, "maximum": 1551.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1551.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLCE CATH ONLY CVAD", "code_information": [{"code": "4916578", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12298.0, "discounted_cash": 9223.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLCE NON-TUNNL CV CATH", "code_information": [{"code": "4916580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5062.0, "discounted_cash": 3796.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPLCMNT BREAST PUMP SHIELD", "code_information": [{"code": "A4284", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.37, "maximum": 42.37, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1178.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS GI TUBE THRU DUODN", "code_information": [{"code": "4907903", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"gross_charge": 2301.0, "discounted_cash": 1725.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1437.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 479.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 455.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS VAD PERC W/IMAGING", "code_information": [{"code": "4613993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21362.0, "discounted_cash": 16021.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 588.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPOSG PHRNC NRV STIM TRNSVN", "code_information": [{"code": "33281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1340.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 442.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION INTRAOCULAR LENS", "code_information": [{"code": "66825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3022.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 995.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1734.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 580.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 13599.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1108.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 371.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 214.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 53.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 53.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITIONING OF TEETH", "code_information": [{"code": "D7290", "type": "HCPCS"}], "standard_charges": [{"minimum": 1835.66, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1835.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITN CV CATH W/FLURO", "code_information": [{"code": "4914240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6350.0, "discounted_cash": 4762.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPOSITN CV CATH W/FLURO", "code_information": [{"code": "6296597", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6350.0, "discounted_cash": 4762.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REPR ELBOW LAT LIGMNT W/TISS", "code_information": [{"code": "24343", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2642.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR ELBW MED LIGMNT W/TISSU", "code_information": [{"code": "24345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2630.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 882.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 658.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8002.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8002.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2678.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4029.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1352.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8567.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8567.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2861.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REPR THOR AORTA W SUBCLV", "code_information": [{"code": "4614828", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 29631.0, "discounted_cash": 22223.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 522.24, "maximum": 2879.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 522.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 580.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRGRMG IO RTA ELTRD RA", "code_information": [{"code": "473T", "type": "CPT"}], "standard_charges": [{"minimum": 294.03, "maximum": 294.03, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 294.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPRIZA, 1CM", "code_information": [{"code": "Q4143", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.58, "maximum": 112.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 327.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 108.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 364.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 364.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPS TRNSV LD RT ATR/VNT", "code_information": [{"code": "4613215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12863.0, "discounted_cash": 9647.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.36, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REREMOVE WRIST TENDON LESION", "code_information": [{"code": "25112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1458.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 491.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2632.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 880.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA REDUCE", "code_information": [{"code": "49555", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2206.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 740.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA BLOCKED", "code_information": [{"code": "49521", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2610.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 877.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA REDUCE", "code_information": [{"code": "49520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 28356.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2310.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 774.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 732.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 245.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7285.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7285.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2433.64, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6398.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2139.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM 5 CM/>", "code_information": [{"code": "21936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5141.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1718.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM < 5 CM", "code_information": [{"code": "21935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3720.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1241.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5479.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1841.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4533.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4533.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1522.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2909.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 975.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2331.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 784.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE", "code_information": [{"code": "28341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1789.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 178.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 802.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 178.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1505.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 690.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3673.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1228.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM < 2 CM", "code_information": [{"code": "21015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2553.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 859.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7446.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2502.45, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5585.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1876.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3782.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1274.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 16063.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2566.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 871.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4252.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1428.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3133.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1051.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3606.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9118.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3059.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10164.18, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10164.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3410.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7553.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7553.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2536.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6578.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2212.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5192.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1744.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT INFERIOR TURBINATE", "code_information": [{"code": "30140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 10927.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 648.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 359.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4584.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1524.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3696.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1237.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3115.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1042.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4075.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1367.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2660.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9211.91, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9211.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3053.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3495.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1164.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4871.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1631.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4215.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1406.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5277.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5277.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1760.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6029.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2006.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1728.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 579.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2928.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 984.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7027.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2361.47, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5345.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1795.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6048.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2012.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5819.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6421.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2157.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR 5 CM/>", "code_information": [{"code": "23078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5221.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1758.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4114.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1381.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3645.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4042.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1357.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5682.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1909.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM < 5 CM", "code_information": [{"code": "27329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3794.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1273.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6421.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2157.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10177.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10177.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3416.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7734.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2564.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8849.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8849.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2928.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7900.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2637.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10553.57, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10553.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3523.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11027.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11027.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3675.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11902.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11902.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3961.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10230.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3405.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12135.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12135.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4022.48, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3127.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1050.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESER OMAYA", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8144175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4207.0, "discounted_cash": 3155.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RESER OMAYA", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8155032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4494.0, "discounted_cash": 3370.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERV CLOVERLEAF TITAN", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8155033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20176.0, "discounted_cash": 15132.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RESERV PENL PROSTH FLAT", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "8155034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20174.0, "discounted_cash": 15130.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2849.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 183.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, 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{"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 69835.8, "maximum": 147573.41, "estimated_discounted_cash": 517518.84, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 77834.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 75208.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 72654.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 69835.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 116867.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 147573.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESTORATIVE FOUNDATION", "code_information": [{"code": "D2949", "type": "HCPCS"}], "standard_charges": [{"minimum": 295.17, "maximum": 295.17, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10437.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10437.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3493.26, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN 1 SQ CM", "code_information": [{"code": "Q4191", "type": "HCPCS"}], "standard_charges": [{"minimum": 5829.84, "maximum": 5829.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5829.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTRATA, PER SQ CM", "code_information": [{"code": "A2007", "type": "HCPCS"}], "standard_charges": [{"minimum": 301.51, "maximum": 301.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 301.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESUSCITATION BAG", "code_information": [{"code": "S8999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETAIN CROWN RESIN W HI NBLE", "code_information": [{"code": "D6720", "type": "HCPCS"}], "standard_charges": [{"minimum": 1679.58, "maximum": 1679.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1679.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETEPLASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2993", "type": "HCPCS"}], "standard_charges": [{"minimum": 8731.14, "maximum": 8731.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8731.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULATED PLATELET ASSAY", "code_information": [{"code": "85055", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 135.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "4105045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.13, "gross_charge": 289.0, "discounted_cash": 216.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "4125045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.13, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "4155045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.13, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "4175045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.13, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOCYTE COUNT AUTO", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "7255045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.13, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11004.94, "maximum": 23255.08, "estimated_discounted_cash": 85417.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14493.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11851.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11449.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11004.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18416.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23255.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23081.08, "maximum": 48773.74, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24837.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24856.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24012.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23081.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38625.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 48773.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6859.1, "maximum": 14494.29, "estimated_discounted_cash": 85520.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10026.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7386.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7135.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6859.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11478.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14494.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICYTE/HGB CONCENTRATE", "code_information": [{"code": "85046", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.13, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 151.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL ANTERIOR", "code_information": [{"code": "D3346", "type": "HCPCS"}], "standard_charges": [{"minimum": 1110.78, "maximum": 1110.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1110.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL MOLAR", "code_information": [{"code": "D3348", "type": "HCPCS"}], "standard_charges": [{"minimum": 1665.01, "maximum": 1665.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1665.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL PREMOLAR", "code_information": [{"code": "D3347", "type": "HCPCS"}], "standard_charges": [{"minimum": 1351.6, "maximum": 1351.6, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1351.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 712.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 291.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 38.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETROGRADE FILLING", "code_information": [{"code": "D3430", "type": "HCPCS"}], "standard_charges": [{"minimum": 302.53, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REUSABLE ENEMA BAG", "code_information": [{"code": "A4458", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE ORAL THERMOMETER", "code_information": [{"code": "A4931", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE PULL-ON ANY SIZE", "code_information": [{"code": "T4536", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE RECTAL THERMOMETER", "code_information": [{"code": "A4932", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD BED SIZE", "code_information": [{"code": "T4537", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSABLE UNDERPAD CHAIR SIZE", "code_information": [{"code": "T4540", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REUSE DIAPER/BRIEF ANY SIZE", "code_information": [{"code": "T4539", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"minimum": 1516.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2738.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLC/RMV THRC VRT TETHRG", "code_information": [{"code": "22838", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6997.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2338.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8430.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8430.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2823.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8438.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8438.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2825.15, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 342.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2144.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2314.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV IMP SP NPG/R DTCH CN", "code_information": [{"code": "63688", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1099.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV PERPH NSTIM ELTRD RA", "code_information": [{"code": "64585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 526.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 102.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RMV PRPH SAC/GSTR NPG/R", "code_information": [{"code": "64595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 15017.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 837.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2192.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 727.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 48314.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3154.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1055.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS OCC ADD", "code_information": [{"code": "92944", "type": "CPT"}, {"code": "4612944", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS OCCL MI", "code_information": [{"code": "92941", "type": "CPT"}, {"code": "4612941", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "standard_charge_dollar": 9655.8, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 12069.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 12069.75, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 16897.65, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 14483.7, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 12069.75, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 16897.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2333.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 24139.5, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 16897.65, "methodology": "fee schedule"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 9655.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 12069.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS SGL VES", "code_information": [{"code": "92937", "type": "CPT"}, {"code": "4612937", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2078.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVAS PERC TRANS TOT OCC", "code_information": [{"code": "92943", "type": "CPT"}, {"code": "4612943", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 36209.25, "gross_charge": 48279.0, "discounted_cash": 36209.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 31381.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 19311.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2333.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 36209.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC FEMPOP STNT ATHER", "code_information": [{"code": "4610235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/ATHER", "code_information": [{"code": "4610233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32760.0, "discounted_cash": 24570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/ATHER", "code_information": [{"code": "4918180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 32760.0, "discounted_cash": 24570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/STENT", "code_information": [{"code": "4610231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/TLA", "code_information": [{"code": "4610229", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 80869.0, "discounted_cash": 60651.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC FEMPOP W/TLA", "code_information": [{"code": "4918176", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 66243.0, "discounted_cash": 49682.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILI W/STENT ADD/O", "code_information": [{"code": "4610227", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48038.0, "discounted_cash": 36028.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC ADD ON", "code_information": [{"code": "4610223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19403.0, "discounted_cash": 14552.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC ADD ON", "code_information": [{"code": "4918170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 25583.0, "discounted_cash": 19187.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC INITIAL", "code_information": [{"code": "4610221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34363.0, "discounted_cash": 25772.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC ILIAC W/STENT", "code_information": [{"code": "4610225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 48289.0, "discounted_cash": 36216.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 38929.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHO+STENT", "code_information": [{"code": "4619765", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 101514.0, "discounted_cash": 76135.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIP", "code_information": [{"code": "4619764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 69728.0, "discounted_cash": 52296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 44931.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 35737.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC TIB PER ADD ON", "code_information": [{"code": "4610239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17414.0, "discounted_cash": 13060.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/ATHER", "code_information": [{"code": "4610241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 30349.0, "discounted_cash": 22761.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASC TIBPER W/TLA", "code_information": [{"code": "4610237", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34829.0, "discounted_cash": 26121.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4570.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1531.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVEFENACIN INH NON-COM 1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7677", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERSE T3", "code_information": [{"code": "84482", "type": "CPT"}, {"code": "7254905", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 59.78, "gross_charge": 460.0, "discounted_cash": 345.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 30.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 88.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23473", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 43035.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5851.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1963.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVIS RECONST SHOULDER JOINT", "code_information": [{"code": "23474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6315.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2118.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4766.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1594.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5873.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1962.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2441.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 818.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 367.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 124.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3085.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1025.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ARM/LEG NERVE", "code_information": [{"code": "64708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1877.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 627.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4667.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1565.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9451.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3163.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9250.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9250.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3095.47, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7804.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2612.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5090.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1693.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4918.65, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4918.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1648.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EXTERNAL EAR", "code_information": [{"code": "69300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1727.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 189.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 788.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 189.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2706.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 888.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1652.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 551.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1652.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 551.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1051.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 553.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2494.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 829.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 629.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4029.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1326.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4969.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1666.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8795.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2952.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8138.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2730.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5810.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1949.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7291.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2446.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE EYE WITH IMPLANT", "code_information": [{"code": "65093", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2683.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 880.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 443.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 162.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 498.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 138.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 319.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 138.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1599.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 535.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1585.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 660.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67911", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2026.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 676.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1668.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 171.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 747.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 171.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1488.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 139.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 650.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 139.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68362", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2371.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 790.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT", "code_information": [{"code": "26535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1631.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2053.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 692.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1889.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 635.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER/TOE NERVE", "code_information": [{"code": "64702", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1899.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 638.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11030.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1352.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 452.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3257.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1089.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3641.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1208.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FINGER TENDON", "code_information": [{"code": "26390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3225.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1071.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FOOT NERVE", "code_information": [{"code": "64704", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1197.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3584.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1204.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HERNIA & SPERM VEINS", "code_information": [{"code": "55540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2026.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 680.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27134", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6907.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2318.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27137", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5327.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1789.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JOINT REPLACEMENT", "code_information": [{"code": "27138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5531.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1858.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP", "code_information": [{"code": "27437", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2441.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 820.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP WITH IMPLANT", "code_information": [{"code": "27438", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3088.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1038.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE JOINT", "code_information": [{"code": "26530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2013.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 678.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE WITH IMPLANT", "code_information": [{"code": "26531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2339.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 789.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 876.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 293.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOW BACK NERVE(S)", "code_information": [{"code": "64714", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2807.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 943.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2350.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27691", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2733.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 919.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDONS", "code_information": [{"code": "27686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1962.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 657.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2970.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3460.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1158.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3647.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1220.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4229.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1415.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3817.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1263.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69642", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4900.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1620.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69643", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4477.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1482.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69644", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5501.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1832.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5397.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1798.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5742.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1903.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3387.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1122.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4411.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1461.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4236.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1397.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4685.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1070.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 542.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2554.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 837.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3320.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1104.06, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2834.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 951.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3365.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1130.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3402.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1140.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3667.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1230.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4310.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1445.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3198.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1064.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3367.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1131.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25375", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3498.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1175.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS OR ULNA", "code_information": [{"code": "25370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3714.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1248.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5597.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1881.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6430.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2156.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1291.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 433.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1577.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10755.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3599.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10997.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3680.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10996.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3680.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PERQ ARAY", "code_information": [{"code": "63663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1648.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 473.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1074.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 473.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE ELTRD PLATE", "code_information": [{"code": "63664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 23419.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3249.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1090.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5918.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5918.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1983.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6182.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6182.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2069.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 310.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 100.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2567.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3086.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1026.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3334.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1108.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2405.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 802.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2578.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT ELBOW", "code_information": [{"code": "64718", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 16506.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2229.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 750.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ULNAR NERVE AT WRIST", "code_information": [{"code": "64719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1509.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1874.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2553.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 1", "code_information": [{"code": "53400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2911.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 978.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 2", "code_information": [{"code": "53405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3174.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1064.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6509.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2182.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3504.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1165.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1841.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 612.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7193.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2405.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1354.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 600.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 134.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST JOINT", "code_information": [{"code": "25332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3111.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1046.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST/FOREARM TENDON", "code_information": [{"code": "25280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 30798.82, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2099.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 706.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1958.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 890.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 214.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2375.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 791.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2333.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 777.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2547.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 849.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2339.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 780.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/IMPLANT FINGER JOINT", "code_information": [{"code": "26536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2761.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 916.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2916.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2163.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 726.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURORECEIVER", "code_information": [{"code": "61888", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1458.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 487.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE SLING REPAIR", "code_information": [{"code": "57287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "estimated_discounted_cash": 24974.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2723.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 904.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2820.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 947.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 28134.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5115.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1719.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27487", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6371.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2138.76, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7008.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2344.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4471.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1496.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ANKLE JOINT", "code_information": [{"code": "27700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2621.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 880.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2873.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 954.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ARM NERVE(S)", "code_information": [{"code": "64713", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2935.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 983.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BIG TOE", "code_information": [{"code": "28310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 188.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 668.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 188.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5015.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1680.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER NECK", "code_information": [{"code": "52500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1804.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 605.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3765.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1262.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CALF TENDON", "code_information": [{"code": "27687", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 12323.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 564.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1315.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 433.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1230.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 408.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 183.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 869.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 290.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8360.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8360.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2798.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7758.77, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7758.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2597.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7968.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7968.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2667.47, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7659.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7659.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2564.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3014.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1013.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3494.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1172.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2298.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 766.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3809.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1277.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4283.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1435.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1238.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 101.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 526.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 101.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4190.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6076.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CRANIAL NERVE", "code_information": [{"code": "64716", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1879.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 628.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3221.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1080.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2483.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 834.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2154.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1465.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1335.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 105.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 562.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 105.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1706.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 689.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 107.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1674.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1645.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67966", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2365.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 132.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 936.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 132.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2648.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 890.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF FINGER", "code_information": [{"code": "26499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3205.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1066.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT", "code_information": [{"code": "28116", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2142.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 192.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 830.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 192.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT AND ANKLE", "code_information": [{"code": "28262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4051.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 276.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1686.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 276.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT BONES", "code_information": [{"code": "28737", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 33123.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2541.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 846.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT FASCIA", "code_information": [{"code": "28250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1520.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 181.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 181.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1802.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 808.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3094.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 237.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1321.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 237.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5443.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1821.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5620.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1880.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4643.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1553.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5033.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1683.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4644.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6156.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2057.74, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5328.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1789.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6195.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2080.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38274.19, "maximum": 80879.04, "estimated_discounted_cash": 334432.89, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49871.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41218.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39818.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38274.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64050.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80879.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [{"code": "466", "type": "MS-DRG"}], "standard_charges": [{"minimum": 56494.21, "maximum": 119380.64, "estimated_discounted_cash": 388829.99, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 75049.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 60840.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 58774.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 56494.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 94540.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 119380.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "468", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29824.04, "maximum": 63022.63, "estimated_discounted_cash": 332685.53, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40286.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32118.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31027.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 29824.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 49909.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63022.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP TENDON", "code_information": [{"code": "27097", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2518.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 847.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4156.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1393.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3043.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1023.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3876.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1302.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3900.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1305.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2177.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 728.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3644.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1218.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1505.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 505.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66761", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 856.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 357.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1539.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 56.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 575.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 56.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 729.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1501.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 499.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4186.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1403.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5049.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1693.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2934.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 986.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3027.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1018.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3188.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3002.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1008.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4576.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1537.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4189.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1407.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3702.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1238.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 846.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 283.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1886.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 703.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EYELID", "code_information": [{"code": "15821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2010.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 753.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3923.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1316.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG TENDON", "code_information": [{"code": "27685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1722.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 197.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 799.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 197.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4407.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1475.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1636.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 548.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4744.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4744.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1589.2, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5152.45, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5152.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1725.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5904.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1978.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1283.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1961.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 659.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2002.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 673.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1913.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 639.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1540.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 623.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3926.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1298.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4889.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1621.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6378.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2122.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3024.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1010.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5808.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1937.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5098.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1712.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2353.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 789.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2722.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 912.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2561.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 858.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2331.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 782.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1518.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 509.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6773.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2255.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8588.64, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8588.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2860.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5459.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1824.47, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7752.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2591.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3888.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1300.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2492.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 838.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25355", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2819.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 947.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCIATIC NERVE", "code_information": [{"code": "64712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 10237.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2186.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1339.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 449.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2513.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 842.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SPINAL SHUNT", "code_information": [{"code": "63744", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2515.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 878.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TESTIS", "code_information": [{"code": "54660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1316.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 442.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF THIGH MUSCLES", "code_information": [{"code": "27430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2735.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 917.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOE", "code_information": [{"code": "28312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1274.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 679.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 205.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8480.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2837.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8699.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2904.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF ULNA", "code_information": [{"code": "25360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2426.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 815.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2763.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 924.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UNSTABLE KNEECAP", "code_information": [{"code": "27422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2732.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7205.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7205.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1458.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 559.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EYELID", "code_information": [{"code": "15823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2012.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 754.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 75.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3364.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1128.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1498.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 503.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53460", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1676.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1273.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 423.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3937.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1320.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3357.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1116.19, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2287.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2696.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 906.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", "code_information": [{"code": "21275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3076.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1032.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7202.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2409.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1325.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5555.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6608.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5555.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 250.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL OF KNEECAP", "code_information": [{"code": "27424", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2758.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 927.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVITA, PER SQ CM", "code_information": [{"code": "Q4180", "type": "HCPCS"}], "standard_charges": [{"minimum": 2331.36, "maximum": 2331.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2331.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVITALON 1 SQUARE CM", "code_information": [{"code": "Q4157", "type": "HCPCS"}], "standard_charges": [{"minimum": 675.65, "maximum": 675.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 675.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4378.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1462.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4223.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1406.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ PERI-IMPLT CAPSULE BRST", "code_information": [{"code": "19370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2454.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 826.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5120.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1715.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ RECONSTRUCTED BREAST", "code_information": [{"code": "19380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2947.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 991.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA PN W/INT NSTIM", "code_information": [{"code": "64598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": [{"code": "785T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 989.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3434.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4095.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3434.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVSN INTRHEP PORTO SHNT", "code_information": [{"code": "4917183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 49130.0, "discounted_cash": 36847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVSN/RELOC PM SKN POCKT", "code_information": [{"code": "4613222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 12769.0, "discounted_cash": 9576.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RF ABLATION ADRENAL TUMOR", "code_information": [{"code": "5050697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23416.0, "discounted_cash": 17562.0, "setting": "both", "billing_class": 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"plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 565.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RF 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QUAL", "code_information": [{"code": "86430", "type": "CPT"}, {"code": "4106431", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.29, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", 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"RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 24.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH 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"standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVAROXABAN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310638", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVAROXABAN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310638", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 1.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310665", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 1.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310665", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 13.3MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337162", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 13.3MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337162", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 3MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310666", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 3MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310666", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 4.6MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338009", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 4.6MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338009", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 9.5MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338010", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIVASTIGMINE 9.5MG TD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5338010", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV BATTERY ONLY", "code_information": [{"code": "862T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RLCJ PG WCS LV TRNSMTR ONLY", "code_information": [{"code": "863T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11870.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1950.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 648.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2203.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 723.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11870.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1748.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 581.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV PRSTC MTRL/MESH ABD WALL", "code_information": [{"code": "11008", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 975.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 326.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3028.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1012.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV TUNLD CVAD W SQ PORT", "code_information": [{"code": "4916590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8392.0, "discounted_cash": 6294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RMV&RPLC PM DUL W/L VNT LEAD", "code_information": [{"code": "C7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1887.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2915.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM LD", "code_information": [{"code": "33288", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1823.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 594.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1383.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 465.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1415.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 44137.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1380.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 36969.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1440.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 481.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9405.84, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9405.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"minimum": 1516.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4678.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3275.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1100.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1844.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1010.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 231.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 77.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2441.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 818.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL EXT FIXJ SYS UNDER ANES", "code_information": [{"code": "20694", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 17414.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1263.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 531.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW DEEP", "code_information": [{"code": "24201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1485.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 751.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW SUBQ", "code_information": [{"code": "24200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 521.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 27060.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2661.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 890.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 447.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 150.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLT VSTIBULAR DEV UNI", "code_information": [{"code": "726T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "447T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 241.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 120.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL INTACT BREAST IMPLANT", "code_information": [{"code": "19328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2025.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 682.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL NINFCT MESH HERNIA RPR", "code_information": [{"code": "49623", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 33462.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 711.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 244.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1240.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 416.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 664.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 221.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 570.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 190.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 903.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BOTH COMPNT", "code_information": [{"code": "861T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM PG ONLY", "code_information": [{"code": "33280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 751.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2051.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 686.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33279", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1239.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 412.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4587.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1541.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6529.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL RUPTURED BREAST IMPLANT", "code_information": [{"code": "19330", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2358.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 793.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1538.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS EA ADDL 10", "code_information": [{"code": "11201", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SKIN TAGS UP TO&INC 15", "code_information": [{"code": "11200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "4613273", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8374.0, "discounted_cash": 6280.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7683.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 304.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 154.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TIS XPNDR WO INSJ IMPLT", "code_information": [{"code": "11971", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2023.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 681.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", "code_information": [{"code": "20665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 358.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22864", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7533.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7533.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2522.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8237.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8237.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2759.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10432.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1329.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 444.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11870.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1859.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1427.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RN TELEPHONE CALLS TO DMP", "code_information": [{"code": "S0320", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.55, 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{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAWIRE DRIVE EXTRA SUPPORT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8246902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4502.0, "discounted_cash": 3376.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUT FOOT CARE PER VISIT", "code_information": [{"code": "S0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 66.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 66.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2059.64, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1843.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2048.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2059.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 663.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2048.75, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1843.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2048.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1339.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 433.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2640.61, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2091.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2323.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2640.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 853.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1480.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 248.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 248.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 999.97, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 899.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 999.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 249.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3823.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1284.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4567.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 265.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 316.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 391.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2550.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 837.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC PICC NO PRT/PMP W/IMG", "code_information": [{"code": "4916584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4624.0, "discounted_cash": 3468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLC PICC NO PRT/PMP W/IMG", "code_information": [{"code": "6296584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4624.0, "discounted_cash": 3468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLC TUNNL CVAD W PORT", "code_information": [{"code": "4916582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8046.0, "discounted_cash": 6034.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2357.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 785.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12014.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12014.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4020.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2054.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT TISS XPNDR PERM IMPLT", "code_information": [{"code": "11970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2054.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 691.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 NCR/STRN", "code_information": [{"code": "49594", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 30103.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2693.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 902.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST 3-10 RDC", "code_information": [{"code": "49593", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 28505.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2070.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 693.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 CM RDC", "code_information": [{"code": "49591", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 24445.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1237.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 414.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST < 3 NCR/STRN", "code_information": [{"code": "49592", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 21786.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1718.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 NCR/STRN", "code_information": [{"code": "49596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3695.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1242.12, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN 1ST > 10 RDC", "code_information": [{"code": "49595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 33006.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2785.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 935.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "estimated_discounted_cash": 21485.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3100.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1038.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 RDC", "code_information": [{"code": "49615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 30688.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2308.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 773.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 NCR/STRN", "code_information": [{"code": "49614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 26902.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2064.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 691.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR < 3 RDC", "code_information": [{"code": "49613", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 26370.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1525.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 510.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 NCR/STRN", "code_information": [{"code": "49618", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4477.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1505.53, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR > 10 RDC", "code_information": [{"code": "49617", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3196.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2714.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3676.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1215.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.5 CM/<", "code_information": [{"code": "12011", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1755.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 201.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 136.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 2.6-5.0 CM", "code_information": [{"code": "12013", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1784.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 209.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 5.1-7.5 CM", "code_information": [{"code": "12014", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 7.6-12.5 CM", "code_information": [{"code": "12015", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 340.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 626.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 210.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 12.6-20.0 CM", "code_information": [{"code": "12016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 461.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 267.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [{"code": "12017", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 556.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 185.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FEM HERNIA INIT BLOCKED", "code_information": [{"code": "49553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 14323.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2306.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 774.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2908.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 975.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3668.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1230.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2081.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 697.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3491.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1170.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2248.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 754.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1494.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 502.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2215.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 743.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1526.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 511.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 2481.68, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1165.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1329.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 634.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 164.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1568.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 717.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 615.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2878.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/RMDLG", "code_information": [{"code": "30469", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2799.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HERNIA RDC", "code_information": [{"code": "49621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2683.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.8, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3310.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1133.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6097.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2037.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RPR REM HERNIA INIT REDUCE", "code_information": [{"code": "49550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 12487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2109.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 708.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [{"code": "12005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 342.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 87.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 214.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 87.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 419.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 94.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRK7.6-12.5CM", "code_information": [{"code": "12004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1758.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 161.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 62.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK 2.5CM/<", "code_information": [{"code": "12001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1769.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [{"code": "12007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 521.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 94.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 94.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK2.6-7.5CM", "code_information": [{"code": "12002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1770.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 213.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR TDN/MUSC UPR A/E EACH", "code_information": [{"code": "24341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 28233.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2772.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 930.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 43.43, "maximum": 43.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFITG SPECT XCP APHAKIA", "code_information": [{"code": "92370", "type": "CPT"}], "standard_charges": [{"minimum": 15.74, "maximum": 110.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 2173.77, "maximum": 11983.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2173.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2415.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11983.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3431.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1150.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 80.9, "maximum": 490.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 441.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 490.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 108.97, "maximum": 490.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 441.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 490.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 108.97, "maximum": 490.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 441.27, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 490.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 121.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7449.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2501.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RSV AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}, {"code": "4107634", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 63.18, "maximum": 266.27, "gross_charge": 373.0, "discounted_cash": 279.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 87.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}, {"code": "4157001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 63.18, "maximum": 266.27, "gross_charge": 373.0, "discounted_cash": 279.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 78.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 87.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"minimum": 1924.49, "maximum": 1924.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1924.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"minimum": 1924.49, "maximum": 1924.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1924.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF BIVALENT IM", "code_information": [{"code": "90678", "type": "CPT"}], "standard_charges": [{"minimum": 1141.31, "maximum": 1141.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1141.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF RECOMB ADJT IM", "code_information": [{"code": "90679", "type": "CPT"}], "standard_charges": [{"minimum": 1083.28, "maximum": 1083.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1083.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT VENT ASSIST DEVCE IMPELA RP", "code_information": [{"code": "4613995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 34175.0, "discounted_cash": 25631.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RUBELLA AB", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "4106318", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 472.0, "discounted_cash": 354.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBELLA AB", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "4156318", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 172.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBELLA AB", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "7256278", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBELLA AB/2", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "4126317", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBELLA AB/2", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "4176317", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AB", "code_information": [{"code": "86765", "type": "CPT"}, {"code": "7256715", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.85, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AG IF", "code_information": [{"code": "87283", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 230.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 54.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 54.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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{"payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS BEHAVIORAL HEALTH COMM", "standard_charge_dollar": 1041.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA/EVERNORTH BEHAVIORAL HEALTH", "standard_charge_dollar": 1416.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "plan_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION - TRADITIONAL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION MILL BILL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS 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678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Ob", "code_information": [{"code": "122", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Oncology", "code_information": [{"code": "127", "type": "RC"}], "standard_charges": [{"minimum": 7070.0, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Other", "code_information": [{"code": "129", "type": "RC"}], "standard_charges": [{"minimum": 7070.0, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Pediatric", "code_information": [{"code": "123", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Psychiatric", "code_information": [{"code": "124", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1416.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS BEHAVIORAL HEALTH COMM", "standard_charge_dollar": 1041.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA/EVERNORTH BEHAVIORAL HEALTH", "standard_charge_dollar": 1416.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 816.39, "methodology": "per diem"}, {"payer_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "plan_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 816.39, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION - TRADITIONAL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION MILL BILL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) Rehabilitation", "code_information": [{"code": "128", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2091.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2323.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1771.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "PRESBYTERIAN MEDICARE ADVANTAGE", "plan_name": "PRESBYTERIAN MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "plan_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "TRICARE", "plan_name": "TRICARE TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION - TRADITIONAL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION MILL BILL", "standard_charge_dollar": 1.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Detoxification", "code_information": [{"code": "156", "type": "RC"}], "standard_charges": [{"minimum": 739.87, "maximum": 1416.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA/EVERNORTH BEHAVIORAL HEALTH", "standard_charge_dollar": 1416.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 739.87, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 739.87, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward General", "code_information": [{"code": "150", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Medical/Surgical/Gyn", "code_information": [{"code": "151", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Ob", "code_information": [{"code": "152", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Oncology", "code_information": [{"code": "157", "type": "RC"}], "standard_charges": [{"minimum": 7070.0, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Other", "code_information": [{"code": "159", "type": "RC"}], "standard_charges": [{"minimum": 7070.0, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Pediatric", "code_information": [{"code": "153", "type": "RC"}], "standard_charges": [{"minimum": 678.64, "maximum": 7070.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7070.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 678.64, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Psychiatric", "code_information": [{"code": "154", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1416.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS BEHAVIORAL HEALTH COMM", "standard_charge_dollar": 1041.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA/EVERNORTH BEHAVIORAL HEALTH", "standard_charge_dollar": 1416.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 816.39, "methodology": "per diem"}, {"payer_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "plan_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 816.39, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION - TRADITIONAL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION MILL BILL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION VACCN", "standard_charge_dollar": 1.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Room And Board Ward Rehabilitation", "code_information": [{"code": "158", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2091.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2323.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1771.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA MEDICARE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "PRESBYTERIAN MEDICARE ADVANTAGE", "plan_name": "PRESBYTERIAN MEDICARE ADVANTAGE", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "plan_name": "PRIME HEALTH SERVICES MEDICARE ADVANTAGE PPO", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "TRICARE", "plan_name": "TRICARE TRADITIONAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION - TRADITIONAL", "standard_charge_dollar": 1.0, "methodology": "per diem"}, {"payer_name": "VETERANS ADMINISTRATION", "plan_name": "VETERANS ADMINISTRATION MILL BILL", "standard_charge_dollar": 1.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Rpr intst excl anrect fist", "code_information": [{"code": "C9796", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S BOWEL ENDOSCOPE W/STENT", "code_information": [{"code": "44379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1470.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 489.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1748.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SACITUZUMAB GOVITECAN-HZIY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9317", "type": "HCPCS"}], "standard_charges": [{"minimum": 129.25, "maximum": 129.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 129.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACROILIAC JOINTS 3 VWS", "code_information": [{"code": "72202", "type": "CPT"}, {"code": "4902202", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 119.4, "gross_charge": 1386.0, "discounted_cash": 1039.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 66.01, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 107.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 119.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACRUM COCCYX 2 VWS", "code_information": [{"code": "72220", "type": "CPT"}, {"code": "4902220", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.23, "gross_charge": 1343.0, "discounted_cash": 1007.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 58.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 99.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALS 97-103MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310709", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALS 97-103MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310709", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALSAR 24-26MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310707", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALSAR 24-26MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310707", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALSAR 49-51MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310708", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACUBIT/VALSAR 49-51MGTB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310708", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 87.0, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALES TAX", "code_information": [{"code": "S9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALICYLATE", "code_information": [{"code": "80179", "type": "CPT"}, {"code": "7252011", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.82, "maximum": 70.7, "gross_charge": 239.0, "discounted_cash": 179.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA SUBST 30ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316261", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SALIVA SUBST 30ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316261", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3650", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 490.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 339.95, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 135.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 441.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 490.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 657.72, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 267.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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[{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 247.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 50 MCG/0.5ML IM", "code_information": [{"code": "91322", "type": "CPT"}], "standard_charges": [{"minimum": 553.47, "maximum": 553.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 553.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 5MCG/0.5ML IM", "code_information": [{"code": "91304", "type": "CPT"}], "standard_charges": [{"minimum": 562.12, "maximum": 562.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 562.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2&INF A&B&RSV AMP PRB", "code_information": [{"code": "87637", "type": "CPT"}], "standard_charges": [{"minimum": 97.16, "maximum": 541.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 97.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 107.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 128.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 128.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 128.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 128.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 10MCG TRS-SUC IM", "code_information": [{"code": "91319", "type": "CPT"}], "standard_charges": [{"minimum": 332.95, "maximum": 332.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 332.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 30MCG TRS-SUC IM", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"minimum": 497.26, "maximum": 497.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 497.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3821.12, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2238.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3610.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1182.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1841.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1041.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2342.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS HIGH 50", "code_information": [{"code": "99233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 431.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 431.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS MODERATE 35", "code_information": [{"code": "99232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 286.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 286.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP IP/OBS SF/LOW 25", "code_information": [{"code": "99231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NB EM PER DAY HOSP", "code_information": [{"code": "99462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 148.23, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE HIGH MDM 45", "code_information": [{"code": "99310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 560.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 560.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE LOW MDM 20", "code_information": [{"code": "99308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 271.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE MODERATE MDM 30", "code_information": [{"code": "99309", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 392.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 392.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 131.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ NF CARE SF MDM 10", "code_information": [{"code": "99307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 146.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ PSYC COLLAB CARE MGMT", "code_information": [{"code": "99493", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 373.61, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 373.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3848.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1007.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"minimum": 350.34, "maximum": 1995.99, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 350.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 389.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1995.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 473.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"minimum": 458.28, "maximum": 1931.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1727.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1919.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1931.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 458.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"minimum": 189.1, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 189.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION ADDL HR", "code_information": [{"code": "96370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 219.05, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 219.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION UP TO 1 HR", "code_information": [{"code": "96369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 513.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 513.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 167.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAFFLD SURG SLK BIORSRB", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "4024685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38671.0, "discounted_cash": 29003.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCAN HEMO COMP PREOP BI STDY", "code_information": [{"code": "93985", "type": "CPT"}, {"code": "5063985", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 764.71, "gross_charge": 1928.0, "discounted_cash": 1446.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 337.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 375.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 764.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 251.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN HEMO COMP PREOP UNI STD", "code_information": [{"code": "93986", "type": "CPT"}, {"code": "5063986", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 445.18, "gross_charge": 928.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 162.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 180.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN HEMODIALYSIS ACCESS", "code_information": [{"code": "93990", "type": "CPT"}, {"code": "5067160", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 450.04, "gross_charge": 6672.0, "discounted_cash": 5004.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 450.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL EXTRA", "code_information": [{"code": "61782", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 624.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 209.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 845.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 283.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAN PROC SPINAL", "code_information": [{"code": "61783", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 830.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 278.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCAPULA COMPLETE", "code_information": [{"code": "73010", "type": "CPT"}, {"code": "4903010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.97, "gross_charge": 1378.0, "discounted_cash": 1033.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 97.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCINTIMAMMOGRAPHY", "code_information": [{"code": "S8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLEROTHERAPY FLUID COLL", "code_information": [{"code": "4919186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6225.0, "discounted_cash": 4668.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLEROTHERAPY FLUID COLL", "code_information": [{"code": "5050918", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6544.0, "discounted_cash": 4908.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLEROTHERAPY FLUID COLL", "code_information": [{"code": "5060919", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7327.0, "discounted_cash": 5495.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.84, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCOLIOSIS DNA ALYS", "code_information": [{"code": "4M", "type": "CPT"}], "standard_charges": [{"minimum": 54.35, "maximum": 299.65, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 54.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 60.4, "methodology": 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{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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1.0, "maximum": 87.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0143", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", 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"billing_class": "facility"}]}, {"description": "SCRW LOCK NON-LOCK DEPUY CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1250.0, "discounted_cash": 937.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW LOCKG/NONLCKNG TORNIER CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4013516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 387.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9294.0, "discounted_cash": 6970.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW LOCKING EXPLOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 775.0, "discounted_cash": 581.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW MANDIBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1421.0, "discounted_cash": 1065.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW MAX FACIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 1217.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW METAPHYSEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5897.0, "discounted_cash": 4422.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW MONOAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8135009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13178.0, "discounted_cash": 9883.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW MULTIAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9294.0, "discounted_cash": 6970.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW NEURO SLF-TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 671.0, "discounted_cash": 503.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW PLT HEAD NONLCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 874.0, "discounted_cash": 655.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11359.0, "discounted_cash": 8519.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SACRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6971.0, "discounted_cash": 5228.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SET SPINAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SHAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 209.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SLF-DRL VAR ANG STRUXXURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 774.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SLFTAP SLF DRLL ULRICH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8130271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1550.0, "discounted_cash": 1162.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW SOLID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6360.0, "discounted_cash": 4770.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW TENDONESIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8260.0, "discounted_cash": 6195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW THR HIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1147.0, "discounted_cash": 860.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW TIBIAL FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3507.0, "discounted_cash": 2630.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW TIT SLF DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4592.0, "discounted_cash": 3444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW TITAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22201.0, "discounted_cash": 16650.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW TWIST-OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4718.0, "discounted_cash": 3538.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRW VARIOUS NEON3 ULRICH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9294.0, "discounted_cash": 6970.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT HEMOSTAT MATRIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5337239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 11122.0, "discounted_cash": 8341.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEC ART THROMBECTOMY ADD-ON", "code_information": [{"code": "37186", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 859.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 967.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1365.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 967.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEC CLSR SURG WND/DEHSN XTN", "code_information": [{"code": "13160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 15069.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2899.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 975.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SECOND STAGE IMPLANT SURGERY", "code_information": [{"code": "D6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 436.88, "maximum": 436.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 436.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDATION (NON-IV)", "code_information": [{"code": "D9248", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.82, "maximum": 303.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 303.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDATIVE HYPNOTICS", "code_information": [{"code": "80368", "type": "CPT"}, {"code": "7251283", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 170.0, "discounted_cash": 127.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDIMENTN RATE-NON-AUTO", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "4105651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 389.0, "discounted_cash": 291.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDIMENTN RATE-NON-AUTO", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "4125651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDIMENTN RATE-NON-AUTO", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "4155651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEDIMENTN RATE-NON-AUTO", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "4175651", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 16.2, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTECTOMY", "code_information": [{"code": "32484", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5113.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5113.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1712.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21020.09, "maximum": 44418.57, "estimated_discounted_cash": 112435.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22296.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22637.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21868.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21020.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35176.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44418.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9795.92, "maximum": 20700.23, "estimated_discounted_cash": 77249.11, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11024.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10549.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10191.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9795.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16393.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20700.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEL DEB 1ST 20CM OR LESS", "code_information": [{"code": "97597", "type": "CPT"}, {"code": "6907597", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "gross_charge": 1050.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 121.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEL DEB EAADD UPTO 20CM", "code_information": [{"code": "97598", "type": "CPT"}, {"code": "6907598", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "gross_charge": 1247.0, "discounted_cash": 935.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELECT PICTURE AUDIOMETRY", "code_information": [{"code": "92583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 206.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 206.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 71.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELEGILINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310719", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELEGILINE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310719", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 55.0, "discounted_cash": 41.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELENIUM", "code_information": [{"code": "84255", "type": "CPT"}, {"code": "7254255", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.84, "gross_charge": 664.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 49.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 57.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 26.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 29.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE 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"both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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LESS", "code_information": [{"code": "87184", "type": "CPT"}, {"code": "4157184", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.37, "gross_charge": 50.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSITV 12 DISKS OR LESS", "code_information": [{"code": "87184", "type": "CPT"}, {"code": "4177184", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.37, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSORIMOTOR EXAMINATION", "code_information": [{"code": "92060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 99.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.15, "methodology": "fee 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"code_information": [{"code": "97533", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 227.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 227.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 75.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1442.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 215.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 718.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 215.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPARATOR INDIGO", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "8177024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18535.0, "discounted_cash": 13901.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 728.26, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 118.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 78.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 87.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 728.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13101.74, "maximum": 27685.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16774.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14109.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13630.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13101.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21925.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27685.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20956.06, "maximum": 44283.26, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27860.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22568.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21801.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20956.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35069.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44283.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9486.61, "maximum": 20046.61, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12223.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10216.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9869.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9486.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15875.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20046.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"minimum": 75013.77, "maximum": 158515.22, "estimated_discounted_cash": 549781.22, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 85517.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80785.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 78041.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 75013.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 125532.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 158515.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21081.95, "maximum": 44549.29, "estimated_discounted_cash": 133206.34, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26329.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22703.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21932.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21081.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35279.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44549.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11105.87, "maximum": 23468.36, "estimated_discounted_cash": 70972.81, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15338.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11960.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11554.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11105.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18585.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23468.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRN PROCES", "code_information": [{"code": "24138", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2545.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 856.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2338.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 786.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2754.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 926.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 496.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 312.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 178.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 446.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 496.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 103.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SERMORELIN ACETATE INJECTION", "code_information": [{"code": "Q0515", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.83, "maximum": 6.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEROTONIN", "code_information": [{"code": "84260", "type": "CPT"}, {"code": "7254260", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 117.51, "gross_charge": 489.0, "discounted_cash": 366.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 60.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 69.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 32.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 748.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 29.22, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 30.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX HORMONE BIND GLOBULN", "code_information": [{"code": "84270", "type": "CPT"}, {"code": "7254270", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 82.42, "gross_charge": 386.0, "discounted_cash": 289.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"minimum": 2172.0, "maximum": 15183.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15183.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 2172.0, "maximum": 14382.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14382.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 132.96, "maximum": 733.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 147.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 733.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 173.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGD ACCESSORY NOC", "code_information": [{"code": "E2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9036.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 365.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 591.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 591.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 70.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 119.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 70.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 135.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 71.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 71.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 138.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 185.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 177.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 146.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 226.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 78.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 215.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 164.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 225.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 268.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11303", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 182.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 85.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11308", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 253.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 174.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 347.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 90.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 218.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 90.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHEATH CLOTTRIEVER", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8360.0, "discounted_cash": 6270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH GUIDE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4646.0, "discounted_cash": 3484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH LONG BALLAST 088", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3679.0, "discounted_cash": 2759.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH STEERABLE TOURGUIDE", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8177128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4006.0, "discounted_cash": 3004.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL ACCESS", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8041028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIGA-TOXIN IA", "code_information": [{"code": "87427", "type": "CPT"}, {"code": "7256634", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.44, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIGELLA ANTIBODY", "code_information": [{"code": "86771", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 92.85, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 92.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHLDR PRM TTL PRFRM PLS CAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 55934.0, "discounted_cash": 41950.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 48621.0, "discounted_cash": 36465.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT ARTERY", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT CAROTID", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9799.0, "discounted_cash": 7349.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT CAROTID", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8177140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4575.0, "discounted_cash": 3431.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT PERITO-VEN", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11806.0, "discounted_cash": 8854.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT UNI KIT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 301.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT VALVE FL", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39071.0, "discounted_cash": 29303.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT VENTRICULR", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8176075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 43802.0, "discounted_cash": 32851.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHNT-PERI DENVE", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8177080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 826.0, "discounted_cash": 619.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHO ARTHRS DX +- SYNOVIAL BX", "code_information": [{"code": "29805", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1727.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 584.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG BICP TENODSIS", "code_information": [{"code": "29828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 12310.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3357.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1126.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG CAPSULORRAPHY", "code_information": [{"code": "29806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3879.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1300.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG COMPL SYNVCT", "code_information": [{"code": "29821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2184.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DECOMPRESSION", "code_information": [{"code": "29826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 13008.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 618.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG DSTL CLAVICLC", "code_information": [{"code": "29824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 12251.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2494.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 838.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LMTD DBRDMT", "code_information": [{"code": "29822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1998.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 672.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG LSS&RESCJ ADS", "code_information": [{"code": "29825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2160.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 727.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG PRTL SYNVCT", "code_information": [{"code": "29820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1966.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 663.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RMVL LOOSE/FB", "code_information": [{"code": "29819", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2165.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 726.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RPR SLAP LES", "code_information": [{"code": "29807", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 20816.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3788.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1270.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG RT8TR CUF RPR", "code_information": [{"code": "29827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 13882.55, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3908.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1311.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG XTNSV DBRDMT", "code_information": [{"code": "29823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2185.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 733.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOE HEEL PAD REMOVABLE FOR", "code_information": [{"code": "L3485", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.8, "maximum": 44.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOE LIFT ELEV HEEL/SOLE COR", "code_information": [{"code": "L3320", "type": "HCPCS"}], "standard_charges": [{"minimum": 295.47, "maximum": 295.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED PLASTAZOTE CUST", "code_information": [{"code": "L3252", "type": "HCPCS"}], "standard_charges": [{"minimum": 437.14, "maximum": 437.14, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 437.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED PLASTAZOTE CUST", "code_information": [{"code": "L3253", "type": "HCPCS"}], "standard_charges": [{"minimum": 108.97, "maximum": 108.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOE MOLDED TO PT SILICONE S", "code_information": [{"code": "L3251", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.19, "maximum": 110.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOE STYLED POSITIONING DEV", "code_information": [{"code": "L3160", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.04, "maximum": 38.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3713.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1248.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS OR ULNA", "code_information": [{"code": "25390", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2831.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 952.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4889.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1642.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2493.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 826.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4551.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1529.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER 2 VWS MINIMUM", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "4903030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 97.39, "gross_charge": 3045.0, "discounted_cash": 2283.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 58.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 97.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER ARTHROGRAPHY", "code_information": [{"code": "73040", "type": "CPT"}, {"code": "4903040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.52, "gross_charge": 3483.0, "discounted_cash": 2612.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 214.81, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 120.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 340.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 378.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 382.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 124.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1701.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 571.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3874.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1306.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4624.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1551.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SHOULDER SINGLE VIEW", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "4903020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.9, "gross_charge": 1112.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [{"code": "511", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22567.73, "maximum": 47688.96, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24051.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24304.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23478.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22567.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37766.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47688.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC", "code_information": [{"code": "510", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32781.49, "maximum": 69272.15, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33300.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 35303.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 34104.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 32781.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 54858.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 69272.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "512", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17966.06, "maximum": 37964.94, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18885.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19348.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18691.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17966.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30065.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37964.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHTH AMPLATZ", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6047.0, "discounted_cash": 4535.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUID FLEXOR SHUTTLE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8073261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 490.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUIDE BI-DIRECTNL VIZIGO", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8073526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7875.0, "discounted_cash": 5906.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUIDE DESTINATION SLENDER", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8177117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2581.0, "discounted_cash": 1935.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUIDING ANSEL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8073257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 652.0, "discounted_cash": 489.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUIDING DESTINATION", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8178597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 798.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH GUIDING FLEXR RAABE", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8073259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 393.0, "discounted_cash": 294.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH INTRO DRYSEAL FLEX", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4104.0, "discounted_cash": 3078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH INTRO SLENDER KIT", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 786.0, "discounted_cash": 589.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH INTRODUCER MICRA", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 784.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH INTRODUCER SENTRANT", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8177106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4180.0, "discounted_cash": 3135.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH NEUROVASC AXS INFINITY LS", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8177116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6630.0, "discounted_cash": 4972.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH STEERABLE FARADRIVE", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8178590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7085.0, "discounted_cash": 5313.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH STEERBL INTRAVASCLR", "code_information": [{"code": "C1766", "type": "HCPCS"}, {"code": "8177126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5574.0, "discounted_cash": 4180.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHTH URETERAL ACCESS DL", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8041319", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1368.0, "discounted_cash": 1026.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIALIDASE ENZYME ASSAY", "code_information": [{"code": "87905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALODOCHOPLASTY", "code_information": [{"code": "D7982", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2725.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIALOENDOSCOPY CAPT & INTERP", "code_information": [{"code": "D0371", "type": "HCPCS"}], "standard_charges": [{"minimum": 587.31, "maximum": 587.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 587.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SICKLING OF RBC", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "7255660", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.9, "gross_charge": 190.0, "discounted_cash": 142.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIG W/TNDSC BALLOON DILATION", "code_information": [{"code": "45340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 283.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 393.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 532.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 393.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & DECOMPRESS", "code_information": [{"code": "45337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 411.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 137.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & POLYPECTOMY", "code_information": [{"code": "45333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 340.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 244.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 388.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 244.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY AND BIOPSY", "code_information": [{"code": "45331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7588.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 261.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 224.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 339.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 224.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FOR BLEEDING", "code_information": [{"code": "45334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8740.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 424.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 390.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 574.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 390.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 577.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2200.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2599.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2200.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/FB REMOVAL", "code_information": [{"code": "45332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 10825.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 380.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 180.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 331.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 180.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 554.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 185.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 711.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/SUBMUC INJ", "code_information": [{"code": "45335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6374.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 242.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 234.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 345.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 234.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/TUMR REMOVE", "code_information": [{"code": "45338", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7612.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 433.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 188.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 188.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 447.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 613.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 204.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14345.5, "maximum": 30314.16, "estimated_discounted_cash": 54663.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18409.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15449.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14924.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14345.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24006.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30314.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9014.5, "maximum": 19048.98, "estimated_discounted_cash": 66720.26, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10464.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9708.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9378.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9014.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15085.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19048.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13776.8, "maximum": 29112.42, "estimated_discounted_cash": 138699.23, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16562.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14836.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14332.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13776.8, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23054.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29112.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8687.83, "maximum": 18358.67, "estimated_discounted_cash": 114396.05, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10389.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9356.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9038.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8687.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14538.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL 10MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316336", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL 10MG/1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316336", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 40.0, "discounted_cash": 30.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310777", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310777", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILDENAFIL CITRATE, 25 MG", "code_information": [{"code": "S0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.01, "maximum": 46.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICONE GEL SHEET, EACH", "code_information": [{"code": "A6025", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.32, "maximum": 59.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 59.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER NITRAT 1 STICK EA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337282", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 19.0, "discounted_cash": 14.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER SULFADIA 1%50GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337272", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER SULFADIA 1%50GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337272", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER SULFADIA1%400GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337274", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER SULFADIA1%400GMCR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337274", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER WOUND GEL 45ML GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334029", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILVER WOUND GEL 45ML GL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5334029", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 165.0, "discounted_cash": 123.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMETHICONE 125MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310786", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 125MG CTB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310786", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 40/.6 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316329", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 40/.6 1ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316329", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 80MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310783", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE 80MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5310783", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE40/.6 30ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316334", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMETHICONE40/.6 30ML LQ", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5316334", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE CYSTOMETROGRAM", "code_information": [{"code": "51725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 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charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 160.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], 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"methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18482.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14265.18, "maximum": 30144.45, "estimated_discounted_cash": 93663.53, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21111.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15362.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14840.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14265.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23872.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30144.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6821.11, "maximum": 14414.02, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10262.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7345.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7096.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6821.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11414.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14414.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMULT PANC KIDN TRANS", "code_information": [{"code": "S2065", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [{"code": "8", "type": "MS-DRG"}], "standard_charges": [{"minimum": 60826.72, "maximum": 128535.9, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 77655.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 65506.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 63281.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 60826.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 101790.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 128535.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [{"code": "19", "type": "MS-DRG"}], "standard_charges": [{"minimum": 77431.81, "maximum": 163624.92, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 83389.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80556.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 77431.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 129578.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 163624.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310791", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310792", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310792", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310793", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310793", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310790", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMVASTATIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310790", "type": "CDM"}, {"code": "637", "type": 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 57842.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 96796.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 122229.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC", "code_information": [{"code": "451", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35059.53, "maximum": 74085.99, "estimated_discounted_cash": 67442.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 55185.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38707.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 37756.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 36474.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 35059.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 58670.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 74085.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11887.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11887.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3973.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23551.01, "maximum": 49766.78, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27899.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25362.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24501.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23551.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39411.54, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 49766.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11019.05, "maximum": 23284.89, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15310.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11866.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11463.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11019.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18439.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23284.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AUG W BONE OR BONE SUB", "code_information": [{"code": "D7951", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4361.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUS AUGMENTATION VERTICAL", "code_information": [{"code": "D7952", "type": "HCPCS"}], "standard_charges": [{"minimum": 3558.74, "maximum": 3558.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3558.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSES 2VW MAX", "code_information": [{"code": "70210", "type": "CPT"}, {"code": "4900210", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.89, "gross_charge": 1878.0, "discounted_cash": 1408.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 62.09, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 92.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 102.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSES 3VW MIN", "code_information": [{"code": "70220", "type": "CPT"}, {"code": "4900220", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.77, "gross_charge": 2238.0, "discounted_cash": 1678.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 77.84, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 114.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 126.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 428.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIPULEUCEL-T AUTO CD54+", "code_information": [{"code": "Q2043", "type": "HCPCS"}], "standard_charges": [{"minimum": 202647.31, "maximum": 202647.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 202647.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS", "code_information": [{"code": "80195", "type": "CPT"}, {"code": "7250254", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.08, "gross_charge": 646.0, "discounted_cash": 484.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS 1MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}, {"code": "5316337", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 10.13, "maximum": 10.13, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS 1MG/ML 1ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}, {"code": "5316337", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 10.13, "maximum": 10.13, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS PER 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}, {"code": "5310800", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 10.13, "maximum": 10.13, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS PER 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}, {"code": "5310800", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 10.13, "maximum": 10.13, "gross_charge": 126.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310796", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310796", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310795", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310795", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310797", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SITAGLIPTIN 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{"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18336.14, "maximum": 38746.99, "estimated_discounted_cash": 129098.47, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21363.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19746.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19076.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18336.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30684.7, "methodology": "case rate"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12440.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 20819.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26289.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "577", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28768.05, "maximum": 60791.15, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28864.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30981.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 29929.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 28768.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48142.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 60791.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "576", "type": "MS-DRG"}], "standard_charges": [{"minimum": 53192.72, "maximum": 112404.12, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 60349.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 57285.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55339.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 53192.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 89015.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 112404.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "578", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17434.26, "maximum": 36841.18, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19175.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18775.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18137.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17434.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29175.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36841.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "574", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37675.1, "maximum": 79613.09, "estimated_discounted_cash": 152006.04, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38313.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 40573.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 39195.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37675.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 63047.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 79613.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "573", "type": "MS-DRG"}], "standard_charges": [{"minimum": 54013.11, "maximum": 150249.81, "estimated_discounted_cash": 277705.48, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 54013.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 76572.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 73971.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 71102.34, "methodology": "case 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"plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20967.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20254.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19469.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32580.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41141.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [{"code": "622", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38628.0, "maximum": 81626.69, "estimated_discounted_cash": 203945.57, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 55430.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41599.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40186.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38628.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64642.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81626.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "624", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13586.87, "maximum": 28711.07, "estimated_discounted_cash": 106161.5, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16483.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14632.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14135.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13586.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22737.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28711.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39864.15, "maximum": 84238.88, "estimated_discounted_cash": 204523.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 49005.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 42931.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 41472.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 39864.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 66710.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84238.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16099.34, "maximum": 34020.3, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20234.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17337.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16749.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16099.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26941.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34020.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP ARMS/LEGS", "code_information": [{"code": "15572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2686.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1078.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP TRUNK", "code_information": [{"code": "15570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2653.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1104.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 187.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 339.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 150.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 399.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT TRNK/ARM/LEG", "code_information": [{"code": "15100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 21209.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2606.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 160.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1056.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 160.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT F/N/HF/G ADDL", "code_information": [{"code": "15276", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 4557.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 90.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT FACE/NK/HF/G", "code_information": [{"code": "15275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 7809.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 338.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 193.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT TRNK/ARM/LEG", "code_information": [{"code": "15271", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 6677.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 304.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 185.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 703.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 120.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 368.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 120.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 8.96, "maximum": 76.54, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST TB INTRADERMAL", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "4106581", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.4, "gross_charge": 294.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TST PPD TB 5T.U", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "4170066", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.4, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12874.91, "maximum": 27206.6, "estimated_discounted_cash": 35734.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14854.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13865.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13394.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12874.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21545.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 27206.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20759.37, "maximum": 44384.17, "estimated_discounted_cash": 62742.51, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20759.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22619.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21851.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 21003.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 35148.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44384.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9407.38, "maximum": 19879.19, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10378.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10131.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9787.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9407.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15742.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19879.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [{"code": "15121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 474.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 79.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 79.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT FAC/NCK/HF/G", "code_information": [{"code": "15120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 12487.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2516.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 165.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 165.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 802.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 412.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 8493.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKULL 4VW MIN", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "4900260", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 145.11, "gross_charge": 3381.0, "discounted_cash": 2535.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 89.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 145.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 37.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL < 4 VIEWS", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "4900250", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 115.71, "gross_charge": 2252.0, "discounted_cash": 1689.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 115.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 99.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9102.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3046.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15146.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15146.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5079.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SKYLA, 13.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7301", "type": "HCPCS"}], "standard_charges": [{"minimum": 3566.48, "maximum": 3566.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3566.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 663.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 175.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1693.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1200.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1693.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 430.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATT&RESP EFFT", "code_information": [{"code": "95806", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1693.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 331.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1693.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 186.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8321.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2779.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10842.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3621.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SLING ARM FASHON", "code_information": [{"code": "A4565", "type": "HCPCS"}, {"code": "8114445", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"minimum": 39.86, "maximum": 295.0, "gross_charge": 295.0, "discounted_cash": 221.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 295.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING SHOULDER", "code_information": [{"code": "A4565", "type": "HCPCS"}, {"code": "8103026", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 39.86, "maximum": 556.0, "gross_charge": 556.0, "discounted_cash": 417.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 556.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING URETH ALIGN TO", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4024701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 53312.0, "discounted_cash": 39984.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING URETH STRATASIS 20", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "8243060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12945.0, "discounted_cash": 9708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 407.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 199.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 515.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 242.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 61.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLNG URETH SUPPORT LYNX BLUE", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "4024702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "gross_charge": 11557.0, "discounted_cash": 8667.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 207.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 17.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 207.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/HRT/O2/RESP", "code_information": [{"code": "95800", "type": "CPT"}, {"code": "6915800", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 353.28, "gross_charge": 244.0, "discounted_cash": 183.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 353.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 108.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM 153 LEXIDRONAM", "code_information": [{"code": "A9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 70407.52, "maximum": 70407.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70407.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM BOWEL SNGL CM STDY", "code_information": [{"code": "74250", "type": "CPT"}, {"code": "4904250", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 382.11, "gross_charge": 2628.0, "discounted_cash": 1971.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 157.66, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 132.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 343.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 382.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 305.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 99.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SM INT IMAGE CAP PROC", "code_information": [{"code": "91110", "type": "CPT"}, {"code": "5070262", "type": "CDM"}, {"code": "750", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2252.21, "gross_charge": 5660.0, "discounted_cash": 4245.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2252.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 709.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.87, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.69, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 172.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 688.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 229.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 733.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 245.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 655.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 218.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 860.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 287.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 881.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 294.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 859.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 288.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 687.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 231.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1018.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 340.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1379.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 460.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 9754.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 267.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 234.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 351.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 234.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44384", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 548.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4009.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 208.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 306.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 927.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 927.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44361", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 8018.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 570.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 190.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44377", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1073.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 357.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 959.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL DISPOSABLE UNDERPAD", "code_information": [{"code": "T4542", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": 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[{"gross_charge": 1550.0, "discounted_cash": 1162.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SP APHASIA EVAL PER HOUR", "code_information": [{"code": "96105", "type": "CPT"}, {"code": "5900810", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1551.0, "discounted_cash": 1163.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP APHASIA EVAL PER HOUR", "code_information": [{"code": "96105", "type": "CPT"}, {"code": "6040810", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1551.0, "discounted_cash": 1163.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP ARTIFICIAL DISC CERV", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "4011245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61956.0, "discounted_cash": 46467.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP BN GRAFT ALLOGRAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 52868.0, "discounted_cash": 39651.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP BN GRFT EXT SYNTHETIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22201.0, "discounted_cash": 16650.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SP BONE AGRFT LOCAL ADD-ON", "code_information": [{"code": "20936", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 451.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT MORSEL ADD-ON", "code_information": [{"code": "20937", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 599.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 201.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE AGRFT STRUCT ADD-ON", "code_information": [{"code": "20938", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 659.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 219.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT MORSEL ADD-ON", "code_information": [{"code": "20930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 423.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BONE ALGRFT STRUCT ADD-ON", "code_information": [{"code": "20931", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 396.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SP BUTTRESS SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3408.0, "discounted_cash": 2556.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CELLULAR BN MATRIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13912.0, "discounted_cash": 10434.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CERV INTERBODY DEV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42336.0, "discounted_cash": 31752.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CERV STANDLNE INT DEV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 25814.0, "discounted_cash": 19360.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CERV STNLN INT DV SCR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CLAMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10815.0, "discounted_cash": 8111.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CLAMP CONNECTOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4131.0, "discounted_cash": 3098.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SP COG FUNC ACTIVITY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "5907130", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY ADDL 15M", "code_information": [{"code": "97130", "type": "CPT"}, {"code": "6047135", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "5907129", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COG FUNC ACTIVITY INIT 15M", "code_information": [{"code": "97129", "type": "CPT"}, {"code": "6047132", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP COMP SCRW WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4279.0, "discounted_cash": 3209.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SP CROSSLINK ASSEMBLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4011219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6196.0, "discounted_cash": 4647.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP EVAL ALT COM DEV 1HR", "code_information": [{"code": "92607", "type": "CPT"}, {"code": "5900027", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1673.0, "discounted_cash": 1254.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SP EVAL BEH QUAL A V/RS BASIC", "code_information": [{"code": "92524", "type": "CPT"}, {"code": "5902524", "type": "CDM"}, {"code": "444", "type": "RC"}], "standard_charges": [{"gross_charge": 339.0, "discounted_cash": 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"ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1573.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"minimum": 1102.13, "maximum": 1102.13, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1102.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99192", "type": "CPT"}], "standard_charges": [{"minimum": 787.5, "maximum": 787.5, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 93.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 84.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 93.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 912.42, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 912.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 515.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 573.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 130.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN ID ENZYM", "code_information": [{"code": "88319", "type": "CPT"}, {"code": "7058319", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 590.54, "gross_charge": 944.0, "discounted_cash": 708.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 167.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 100.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 79.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 88.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 401.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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936.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX CMPLX", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6041009", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX EXTNSV", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901005", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1235.0, "discounted_cash": 926.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX EXTNSV", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "6041010", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 1853.0, "discounted_cash": 1389.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPEECH/LANG TX INTER", "code_information": [{"code": "92507", "type": "CPT"}, {"code": "5901008", "type": "CDM"}, {"code": "440", "type": "RC"}], "standard_charges": [{"gross_charge": 625.0, "discounted_cash": 468.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GN"}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 40.47, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 40.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 40.73, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 39.21, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE INIT VISIT", "code_information": [{"code": "S4030", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE SUBS VISIT", "code_information": [{"code": "S4031", "type": "HCPCS"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERMICIDE", "code_information": [{"code": "A4269", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2546.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 840.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPHINCTERTOME DREAMTOME RX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8035222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2989.0, "discounted_cash": 2241.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHYG/BP APP W CUFF AND STET", "code_information": [{"code": "A4660", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.48, "maximum": 31.48, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 31.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 327.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 143.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61956.0, "discounted_cash": 46467.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL CONN AXL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10413.0, "discounted_cash": 7809.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL DISK SURGERY ADD-ON", "code_information": [{"code": "63035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12128.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 839.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8853.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 279.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "52", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19658.04, "maximum": 41540.35, "estimated_discounted_cash": 97881.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23037.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21170.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20451.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19658.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32896.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41540.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC", "code_information": [{"code": "53", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10627.26, "maximum": 22456.97, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13540.43, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11444.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11056.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10627.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17784.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22456.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [{"code": "457", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52604.0, "maximum": 136757.74, "estimated_discounted_cash": 846427.82, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52604.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 100633.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 69696.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 67329.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 64717.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108301.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 136757.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [{"code": "456", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52604.0, "maximum": 192723.58, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52604.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 137005.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 98218.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 94882.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 91202.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 152622.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 192723.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC", "code_information": [{"code": "458", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45285.23, "maximum": 95694.41, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52604.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 76686.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 48769.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47112.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 45285.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 75782.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 95694.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL ORTHOSIS NOS", "code_information": [{"code": "L1499", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "29", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37026.09, "maximum": 78241.63, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45998.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 39874.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 38520.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 37026.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 61961.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 78241.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "28", "type": "MS-DRG"}], "standard_charges": [{"minimum": 65208.08, "maximum": 137794.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 78625.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 70225.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 67839.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 65208.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 109122.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 137794.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "30", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23824.51, "maximum": 50344.72, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25983.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25657.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24786.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23824.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 39869.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50344.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNCT LUMB DX WFLUOR/CT", "code_information": [{"code": "4902321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5174.0, "discounted_cash": 3880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCT LUMB DX WFLUOR/CT", "code_information": [{"code": "4912328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5174.0, "discounted_cash": 3880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCT LUMB DX WFLUOR/CT", "code_information": [{"code": "5052328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5174.0, "discounted_cash": 3880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCTR LUMB DIAG", "code_information": [{"code": "4908900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2507.0, "discounted_cash": 1880.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCTR LUMB DIAG", "code_information": [{"code": "4918900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2507.0, "discounted_cash": 1880.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE THERAPTC", "code_information": [{"code": "4902135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2180.0, "discounted_cash": 1635.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PUNCTURE THERAPTC", "code_information": [{"code": "4912272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2180.0, "discounted_cash": 1635.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL RECON $1000-$3000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28425.0, "discounted_cash": 21318.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL RECON $5000-$6000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51629.0, "discounted_cash": 38721.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL STIM LEAD", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "8177171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6196.0, "discounted_cash": 4647.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE ANY LEVEL SNGL VW", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "4902020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.9, "gross_charge": 1018.0, "discounted_cash": 763.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 69.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERV 6 > VWS", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "4902052", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 227.8, "gross_charge": 2379.0, "discounted_cash": 1784.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 119.24, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 61.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 205.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 175.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 57.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 2 VIEWS", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "4902040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 124.95, "gross_charge": 1410.0, "discounted_cash": 1057.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 112.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE CERVICAL 4 OR 5 VW", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "4902050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 174.53, "gross_charge": 2094.0, "discounted_cash": 1570.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 94.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 47.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 157.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 174.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 49.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DEVICE IMPLANT SURGERY", "code_information": [{"code": "C9757", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10916.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12128.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5317.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1785.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 741.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": 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{"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310917", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310917", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310910", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310910", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310914", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRONOLACTONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5310914", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 823.04, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 305.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 330.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 740.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 823.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 504.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 165.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30490.42, "maximum": 64430.78, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38466.53, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 32836.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31720.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30490.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 51024.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 64430.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49152.15, "maximum": 103865.79, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 73035.85, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 52933.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 51135.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 49152.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 82253.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 103865.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20717.29, "maximum": 43778.71, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22548.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22311.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21553.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20717.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34669.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43778.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8360.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8360.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2798.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4178.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1400.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPLINT", "code_information": [{"code": "A4570", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.37, "maximum": 42.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLITTING BLD PROD EA UT", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "4106967", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 134.24, "gross_charge": 271.0, "discounted_cash": 203.25, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLITTING BLD PROD EA UT", "code_information": [{"code": "86985", "type": "CPT"}, {"code": "4170068", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.06, "maximum": 134.24, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONGE BLOCK CANCELLOUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4833.0, "discounted_cash": 3624.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS STUDY", "code_information": [{"code": "92531", "type": "CPT"}], "standard_charges": [{"minimum": 55.83, "maximum": 55.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC", "code_information": [{"code": "537", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10357.02, "maximum": 21885.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13075.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11153.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10775.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10357.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17332.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21885.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC", "code_information": [{"code": "538", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7817.42, "maximum": 16519.36, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10077.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8418.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8132.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7817.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13082.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16519.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPRCHOROIDAL SPC NJX RX AGT", "code_information": [{"code": "67516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 350.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPUTUM INDUCTION", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "5500223", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 28.9, "gross_charge": 823.0, "discounted_cash": 617.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPECIMEN COLLECTION", "code_information": [{"code": "89220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.66, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SR89 STRONTIUM", "code_information": [{"code": "A9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 16215.08, "maximum": 16215.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16215.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1089.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 363.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 788.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 263.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5038.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1687.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3729.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1251.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34839.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3010.77, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1763.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 31354.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34839.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3459.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1126.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3256.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7891.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4118.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1380.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 905.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 302.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 120.69, "maximum": 665.29, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 120.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 134.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 665.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST ACCESS LIVER TRNSJUG", "code_information": [{"code": "C1894", "type": "HCPCS"}, {"code": "8034187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3912.0, "discounted_cash": 2934.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ST AFFIXUS LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8177198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19515.0, "discounted_cash": 14636.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ST BATTERY LITH-ION 14V", "code_information": [{"code": "Q0506", "type": "HCPCS"}, {"code": "8145163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 3727.84, "maximum": 3727.84, "gross_charge": 2548.0, "discounted_cash": 1911.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3727.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST BX LIVER TRNSJUG CHOL", "code_information": [{"code": "C1887", "type": "HCPCS"}, {"code": "8248499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4440.0, "discounted_cash": 3330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ST CATH EVD BACTISEAL", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8082681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6190.0, "discounted_cash": 4642.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ST CATH HEMDLY ACUT BASC", "code_information": [{"code": "C1752", "type": "HCPCS"}, {"code": "8056989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13166.0, "discounted_cash": 9874.5, "setting": "both", "billing_class": 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10407.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORAL UNCOATED SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10950.0, "discounted_cash": 8212.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FEMORL UNCOATD STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11922.0, "discounted_cash": 8941.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP MOD OSTEOREMEDIES CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16522.0, "discounted_cash": 12391.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HIP MODULAR REV ZIM 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"278", "type": "RC"}], "standard_charges": [{"gross_charge": 21132.0, "discounted_cash": 15849.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUM CTD UNCEM ZIMMER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30378.0, "discounted_cash": 22783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUM FRACTR REVSN ZIMM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 30378.0, "discounted_cash": 22783.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUM MOD PRX CMP DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13962.0, "discounted_cash": 10471.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL COLLAR DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5625.0, "discounted_cash": 4218.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERAL SHORT STRYKER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19619.0, "discounted_cash": 14714.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMERL CT UNCEM DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22606.0, "discounted_cash": 16954.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM HUMRL COATD TORNIER CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27870.0, "discounted_cash": 20902.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE CEMENTED STRYKR CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4111.0, "discounted_cash": 3083.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE DEPU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12830.0, "discounted_cash": 9622.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE EXTEN COATD DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8812.0, "discounted_cash": 6609.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE EXTEN PRIM EXACT CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4013136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5163.0, "discounted_cash": 3872.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE EXTENSION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 47087.0, "discounted_cash": 35315.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM KNEE EXTN UNCTED DEPUY CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24335.0, "discounted_cash": 18251.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REV NON POR HUM ZIM CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 57382.0, "discounted_cash": 43036.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TALAR ANKLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14795.0, "discounted_cash": 11096.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TIBIAL MID PLASMA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7211.0, "discounted_cash": 5408.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TIBIAL TOP PLASMA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8136599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7211.0, "discounted_cash": 5408.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.77, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT SYSTEM RELAY PRO", "code_information": [{"code": "C1875", "type": "HCPCS"}, {"code": "8062029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172260.0, "discounted_cash": 129195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2935.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 983.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3812.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1279.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALYSIS SEG", "code_information": [{"code": "36908", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 732.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1237.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1619.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1237.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 199.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 51614.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1022.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 690.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46451.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51614.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1549.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26556.0, "methodology": "case rate"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERILE GAUZE > 48 SQ IN", "code_information": [{"code": "A6404", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERILE NEEDLE", "code_information": [{"code": "A4215", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE SALINE OR WATER", "code_information": [{"code": "A4218", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERILE, GLOVES PER PAIR", "code_information": [{"code": "A4930", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2000.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "STERNCLAVR JNTS 3VW MIN", "code_information": [{"code": "71130", "type": "CPT"}, {"code": "4901130", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.77, "gross_charge": 1201.0, "discounted_cash": 900.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 72.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 114.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 126.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 37.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STERNUM 2VW MIN", "code_information": [{"code": "71120", "type": "CPT"}, {"code": "4901120", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.55, "gross_charge": 1311.0, "discounted_cash": 983.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 106.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 88.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": 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{"code": "8067084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150086.0, "discounted_cash": 112564.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASC EPIC SLF EXPND", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10842.0, "discounted_cash": 8131.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASC ILIAC", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11565.0, "discounted_cash": 8673.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASC LIFESTENT", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7744.0, "discounted_cash": 5808.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASC RECONSTR DLV", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "4028700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 71702.0, "discounted_cash": 53776.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASCULAR CAROTID", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20085.0, "discounted_cash": 15063.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASCULAR COVERED COVERA", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8062196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27881.0, "discounted_cash": 20910.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VASCULAR TIGRIS", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8067800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15819.0, "discounted_cash": 11864.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VENOUS VICI", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8067803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15489.0, "discounted_cash": 11616.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STNT VENOUS ZILVER VENA", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8062164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14447.0, "discounted_cash": 10835.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26526.9, "maximum": 56055.28, "estimated_discounted_cash": 137580.91, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38654.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 28567.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 27597.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26526.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44391.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 56055.28, "methodology": "case 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"plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17389.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29100.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 36747.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 262.13, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 39.55, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"STPL FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10976.0, "discounted_cash": 8232.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STPL LIGAMENT SPIKED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 725.0, "discounted_cash": 543.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STPL LINE REINFORCEMENT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "8185138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7816.0, "discounted_cash": 5862.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 251.7, "maximum": 1156.14, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 251.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 279.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1156.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 274.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ANKLE AND/OR FT", "code_information": [{"code": "29540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 34.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH 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14.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 73.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 41.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF PASTE BOOT", "code_information": [{"code": "6900092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 896.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF PASTE BOOT", "code_information": [{"code": "6900092", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 896.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS A IA", "code_information": [{"code": "87430", "type": "CPT"}, {"code": "4156411", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.76, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS A IA/2", "code_information": [{"code": "87430", "type": "CPT"}, {"code": "4176411", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.76, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.02, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3000", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.33, "maximum": 123.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOZOCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9320", "type": "HCPCS"}], "standard_charges": [{"minimum": 1404.11, "maximum": 1404.11, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1404.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS BREAKER", "code_information": [{"code": "D6940", "type": "HCPCS"}], "standard_charges": [{"minimum": 419.89, "maximum": 419.89, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 419.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS TTE ONLY", "code_information": [{"code": "93350", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 428.34, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 428.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 139.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRIATED AB SCR", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "7251260", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.71, "gross_charge": 354.0, "discounted_cash": 265.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRUT FEMORAL CORTICAL SPLIT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "4028736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 8308.0, "discounted_cash": 6231.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBRTA NJX RX AGT W/VTRC", "code_information": [{"code": "810T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 414.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 139.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2403.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 823.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1896.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 636.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2357.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 794.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3222.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1082.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5261.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5261.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1763.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUCCINYLCHOL UPTO 20MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0330", "type": "HCPCS"}, {"code": "5324405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.69, "maximum": 2.69, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCCINYLCHOL UPTO 20MGIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0330", "type": "HCPCS"}, {"code": "5324405", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.69, "maximum": 2.69, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCRALFATE 1G/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316390", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCRALFATE 1G/10ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316390", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCRALFATE 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311006", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCRALFATE 1GM TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311006", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY HEAD&NECK", "code_information": [{"code": "15876", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY LWR EXTREM", "code_information": [{"code": "15879", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY TRUNK", "code_information": [{"code": "15877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH 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"methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY UPR EXTREM", "code_information": [{"code": "15878", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUFENTANIL 50UG/ML1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5327991", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUFENTANIL 50UG/ML2ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5327993", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGAMMADEX 200MG PFS IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324394", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 523.0, "discounted_cash": 392.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGAMMADEX 200MG/2ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324400", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1141.0, "discounted_cash": 855.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, 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- HMO", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUANT", "code_information": [{"code": "84378", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.73, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.38, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"5332151", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFACET/PRED.25% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332151", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFACETAMID NA10%15MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332501", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFACETAMID NA10%15MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332501", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFADIAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFADIAZINE 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311052", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFAMETH/TRIM PER 5MG/1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2865", "type": "HCPCS"}, {"code": "5324408", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.15, "discounted_cash": 0.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFAMETH/TRIM PER 5MG/1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2865", "type": "HCPCS"}, {"code": "5324408", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.15, "discounted_cash": 0.11, "setting": "both", "billing_class": "facility"}]}, {"description": "SULFASALAZIN 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311111", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFASALAZIN 500MG EC TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311111", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFATE URINE", "code_information": [{"code": "84392", "type": "CPT"}, {"code": "7254392", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.82, "gross_charge": 89.0, "discounted_cash": 66.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFUR HEXAFL LIPID MIC 1ML IJ", "code_information": [{"code": "Q9950", "type": "HCPCS"}, {"code": "5324411", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 71.71, "maximum": 71.71, "gross_charge": 1724.0, "discounted_cash": 1293.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULFUR HEXAFL LIPID MIC 1ML IJ", "code_information": [{"code": "Q9950", "type": "HCPCS"}, {"code": "5324411", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 71.71, "maximum": 71.71, "gross_charge": 1724.0, "discounted_cash": 1293.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULINDAC 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311183", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULINDAC 150MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311183", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULINDAC 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311187", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SULINDAC 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311187", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 5.0, "discounted_cash": 3.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311190", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311190", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311191", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311191", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN PER 6MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3030", "type": "HCPCS"}, {"code": "5324420", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 82.99, "maximum": 82.99, "gross_charge": 388.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUMATRIPTAN PER 6MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3030", "type": "HCPCS"}, {"code": "5324420", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 82.99, "maximum": 82.99, "gross_charge": 388.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUP FEE ANTIEM,ANTICA,IMMUNO", "code_information": [{"code": "Q0511", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.03, "maximum": 91.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERIMPOSED PROSTHESIS", "code_information": [{"code": "D5954", "type": "HCPCS"}], "standard_charges": [{"minimum": 8747.57, "maximum": 8747.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8747.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERIOR VENACAVAGRAM", "code_information": [{"code": "75827", "type": "CPT"}, {"code": "4615828", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1406.14, "gross_charge": 14374.0, "discounted_cash": 10780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1056.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 136.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 826.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERIOR VENACAVAGRAM", "code_information": [{"code": "75827", "type": "CPT"}, {"code": "4905827", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1406.14, "gross_charge": 7195.0, "discounted_cash": 5396.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1056.28, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 136.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 826.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPERIOR VENACAVAGRAM", "code_information": [{"code": "75827", "type": "CPT"}, {"code": "4915828", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1406.14, "gross_charge": 14374.0, "discounted_cash": 10780.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1056.28, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 136.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 826.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 239.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 78.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1406.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPLEMENTAL ELECTRICAL TEST", "code_information": [{"code": "92547", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 38.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 38.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 12.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPLY, NOS", "code_information": [{"code": "T5999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUPPRELIN LA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 169076.52, "maximum": 169076.52, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 169076.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFAC TRNSPORT ADDL", "code_information": [{"code": "99486", "type": "CPT"}], "standard_charges": [{"minimum": 230.5, "maximum": 230.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 230.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPRV INTERFACILTY TRANSPORT", "code_information": [{"code": "99485", "type": "CPT"}], "standard_charges": [{"minimum": 266.08, "maximum": 266.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 266.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN THRU TUBE", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 204.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 204.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 67.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG DX EXAM ANORECTAL", "code_information": [{"code": "45990", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 129.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF ANTERIOR", "code_information": [{"code": "D3501", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF MOLAR", "code_information": [{"code": "D3503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF PREMOLAR", "code_information": [{"code": "D3502", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG LEVEL I EA ADD 15 MIN", "code_information": [{"code": "3213551", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3604.0, "discounted_cash": 2703.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL I INT 30 MIN", "code_information": [{"code": "3213550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 16012.0, "discounted_cash": 12009.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL II EA ADD 15 MIN", "code_information": [{"code": "3213553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4904.0, "discounted_cash": 3678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL II INT 30 MIN", "code_information": [{"code": "3213552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17414.0, "discounted_cash": 13060.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL III EA ADD 15 MIN", "code_information": [{"code": "3213555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6588.0, "discounted_cash": 4941.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL III INT 30 MIN", "code_information": [{"code": "3213554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 20499.0, "discounted_cash": 15374.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV EA ADD 15 MIN", "code_information": [{"code": "3213557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7155.0, "discounted_cash": 5366.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG LEVEL IV INT 30 MIN", "code_information": [{"code": "3213556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 27824.0, "discounted_cash": 20868.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PLACE CRANIOFACIAL IMPL", "code_information": [{"code": "D7993", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG PLACE ZYGOMATIC IMPL", "code_information": [{"code": "D7994", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG PROC I", "code_information": [{"code": "4540224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC I", "code_information": [{"code": "6296000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 412.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC II", "code_information": [{"code": "4540225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 1529.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC II", "code_information": [{"code": "6296001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2039.0, "discounted_cash": 1529.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC III", "code_information": [{"code": "4540226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6343.0, "discounted_cash": 4757.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC III", "code_information": [{"code": "6296002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6343.0, "discounted_cash": 4757.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "5606000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6100400", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL I", "code_information": [{"code": "6166000", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 864.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "5606001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4105.0, "discounted_cash": 3078.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6100402", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1861.0, "discounted_cash": 1395.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL II", "code_information": [{"code": "6166001", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 1861.0, "discounted_cash": 1395.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6100404", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 4394.0, "discounted_cash": 3295.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG PROC LEVEL III", "code_information": [{"code": "6166002", "type": "CDM"}, {"code": "450", "type": "RC"}], "standard_charges": [{"gross_charge": 4951.0, "discounted_cash": 3713.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SURG REDCT FIBROUS TUBEROSIT", "code_information": [{"code": "D7972", "type": "HCPCS"}], "standard_charges": [{"minimum": 1147.08, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1147.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REDUCT OSSEOUSTUBEROSIT", "code_information": [{"code": "D7485", "type": "HCPCS"}], "standard_charges": [{"minimum": 878.53, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 878.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REMOVAL OF IMPLANT BODY", "code_information": [{"code": "D6100", "type": "HCPCS"}], "standard_charges": [{"minimum": 1083.05, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1083.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES ANTERIOR", "code_information": [{"code": "D3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES MOLAR", "code_information": [{"code": "D3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES PREMOLAR", "code_information": [{"code": "D3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5256.38, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5256.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1714.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR LIVER LESION", "code_information": [{"code": "47300", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4123.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1377.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR URETHRA POUCH", "code_information": [{"code": "53240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1556.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 521.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR VULVA LESION", "code_information": [{"code": "56440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 666.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 222.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 14755.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14755.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4941.33, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4171.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1396.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2448.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 822.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "estimated_discounted_cash": 14327.34, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2701.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 908.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3367.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1131.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2477.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 833.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY/SPEECH PROSTHESIS", "code_information": [{"code": "31611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1968.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 653.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH CHILD", "code_information": [{"code": "L3209", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.87, "maximum": 96.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH INFANT", "code_information": [{"code": "L3208", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.82, "maximum": 67.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL BOOT EACH JUNIOR", "code_information": [{"code": "L3211", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.94, "maximum": 102.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3177.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1065.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL MASK", "code_information": [{"code": "A4928", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OBTURATOR", "code_information": [{"code": "D5931", "type": "HCPCS"}], "standard_charges": [{"minimum": 3332.49, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3332.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4741.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4741.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1587.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3837.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1285.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2859.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 960.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3454.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1158.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2770.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 920.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL I", "code_information": [{"code": "88300", "type": "CPT"}, {"code": "4120037", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.43, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL I", "code_information": [{"code": "88300", "type": "CPT"}, {"code": "4308300", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 43.43, "gross_charge": 519.0, "discounted_cash": 389.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL II", "code_information": [{"code": "88302", "type": "CPT"}, {"code": "4120038", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 96.72, "gross_charge": 43.0, "discounted_cash": 32.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 55.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 30.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 33.96, "methodology": "fee 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"AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1065.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PATH LEVEL VI", "code_information": [{"code": "88309", "type": "CPT"}, {"code": "4308309", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 1065.04, "gross_charge": 3623.0, "discounted_cash": 2717.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 209.65, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 130.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1065.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL PLACE MINI IMPLANT", "code_information": [{"code": "D6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 2116.49, "maximum": 2116.49, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2116.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4898.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4898.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1633.35, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5522.76, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5522.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1849.77, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3899.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1307.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION PROCEDURE", "code_information": [{"code": "D4268", "type": "HCPCS"}], "standard_charges": [{"minimum": 1089.01, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1089.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7980", "type": "HCPCS"}], "standard_charges": [{"minimum": 923.25, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 923.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPECIMEN", "code_information": [{"code": "76098", "type": "CPT"}, {"code": "4906095", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 482.89, "gross_charge": 3479.0, "discounted_cash": 2609.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.42, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 49.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 55.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 482.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPLINT", "code_information": [{"code": "D5988", "type": "HCPCS"}], "standard_charges": [{"minimum": 1114.46, "maximum": 1114.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1114.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL STENT", "code_information": [{"code": "D5982", "type": "HCPCS"}], "standard_charges": [{"minimum": 562.65, "maximum": 562.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 562.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICAL TRAYS", "code_information": [{"code": "A4550", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.46, "maximum": 71.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 71.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGIGRAFT, 1 SQ CM", "code_information": [{"code": "Q4183", "type": "HCPCS"}], "standard_charges": [{"minimum": 322.41, "maximum": 322.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 322.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT FT PER SQ CM", "code_information": [{"code": "Q4268", "type": "HCPCS"}], "standard_charges": [{"minimum": 3675.42, "maximum": 3675.42, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3675.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT TL, PER SQ CM", "code_information": [{"code": "Q4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 3998.98, "maximum": 3998.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3998.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTBILTY STDY ENZYME", "code_information": [{"code": "87185", "type": "CPT"}, {"code": "4107036", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.02, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTBILTY STDY ENZYME", "code_information": [{"code": "87185", "type": "CPT"}, {"code": "7257185", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 18.02, "gross_charge": 134.0, "discounted_cash": 100.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY MACROBROTH", "code_information": [{"code": "87188", "type": "CPT"}, {"code": "7257001", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.19, "gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.89, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY MYCOBACTERIA", "code_information": [{"code": "87190", "type": "CPT"}, {"code": "7257190", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.73, "gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "4107018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.81, "gross_charge": 572.0, "discounted_cash": 429.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "4127018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.81, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "4157018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.81, "gross_charge": 104.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "4177018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.81, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STUDY MIC", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "7257181", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.81, "gross_charge": 509.0, "discounted_cash": 381.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.79, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3630.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1210.78, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF BREAST", "code_information": [{"code": "19316", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2890.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 971.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF TESTIS", "code_information": [{"code": "54620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1088.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 364.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1704.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2986.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 992.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3528.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1175.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE BILE DUCT INJURY", "code_information": [{"code": "47900", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4996.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4996.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1672.93, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE COMPLICATE WND > 5 CM", "code_information": [{"code": "D7912", "type": "HCPCS"}], "standard_charges": [{"minimum": 889.42, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 889.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3811.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1275.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5074.35, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5074.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1697.34, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44603", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5834.96, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5834.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1954.25, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"minimum": 28.8, "maximum": 160.37, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 160.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWAL FUNC W/CINE/VIDEO+CM STDY", "code_information": [{"code": "74230", "type": "CPT"}, {"code": "4904230", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 361.93, "gross_charge": 1857.0, "discounted_cash": 1392.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 144.85, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 168.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 272.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 303.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 361.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 116.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"minimum": 16.28, "maximum": 68.62, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY CERVICAL", "code_information": [{"code": "64802", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3114.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1044.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2816.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 944.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2908.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": 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[{"gross_charge": 21096.0, "discounted_cash": 15822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T-CELLS ABSOLUTE CD4 CNT", "code_information": [{"code": "86361", "type": "CPT"}, {"code": "7256361", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.58, "gross_charge": 213.0, "discounted_cash": 159.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 28.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 31.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 101.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T3 FREE", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "7253554", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.25, "gross_charge": 307.0, "discounted_cash": 230.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6083.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACRINE HYDROCHLORIDE, 10 MG", "code_information": [{"code": "S0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROL ASTAGRAF EX REL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7508", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.09, "maximum": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROL ENVARSUS EX REL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.57, "maximum": 6.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS", "code_information": [{"code": "80197", "type": "CPT"}, {"code": "7250197", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 52.08, "gross_charge": 204.0, "discounted_cash": 153.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.65, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 52.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS .25MG/.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316413", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS .25MG/.5ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316413", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS 0.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7507", "type": "HCPCS"}, {"code": "5311206", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS 0.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7507", "type": "HCPCS"}, {"code": "5311206", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS PER 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7507", "type": "HCPCS"}, {"code": "5311204", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS PER 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7507", "type": "HCPCS"}, {"code": "5311204", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 0.9, "gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7525", "type": "HCPCS"}, {"code": "5324423", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 943.45, "maximum": 943.45, "gross_charge": 2311.0, "discounted_cash": 1733.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 943.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7525", "type": "HCPCS"}, {"code": "5324423", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 943.45, "maximum": 943.45, "gross_charge": 2311.0, "discounted_cash": 1733.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 943.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 80.9, "maximum": 392.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 392.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAG, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4261", "type": "HCPCS"}], "standard_charges": [{"minimum": 2333.68, "maximum": 2333.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2333.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7918.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2640.73, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7318.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2440.21, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAKE HOME SUPPLY 8MG PER 0.1", "code_information": [{"code": "G1028", "type": "HCPCS"}], "standard_charges": [{"minimum": 484.56, "maximum": 484.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 484.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAKE-HOM BUPRENORPHINE", "code_information": [{"code": "G2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 272.19, "maximum": 272.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 272.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAKE-HOME METH", "code_information": [{"code": "G2078", "type": "HCPCS"}], "standard_charges": [{"minimum": 154.41, "maximum": 154.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALC STERILE 4GM PW SP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337313", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1929.0, "discounted_cash": 1446.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALYMED", "code_information": [{"code": "Q4127", "type": "HCPCS"}], "standard_charges": [{"minimum": 259.77, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10 MG", "code_information": [{"code": "S0187", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.07, "maximum": 6.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5311210", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMOXIFEN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}, {"code": "5311210", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMSULOSIN .4MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311215", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMSULOSIN .4MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311215", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 59.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 136.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 119.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANTALUM RING APPLICATION", "code_information": [{"code": "S8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 279.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 281.81, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 281.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 17241.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 72.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 229.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 157.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNIL BY INJECTION", "code_information": [{"code": "64486", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 15563.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAPENTADOL", "code_information": [{"code": "80372", "type": "CPT"}, {"code": "7250371", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 97.0, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGET GENOMIC ANALYSIS 51+", "code_information": [{"code": "81455", "type": "CPT"}, {"code": "7060037", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 2627.64, "maximum": 11074.04, "gross_charge": 8941.0, "discounted_cash": 6705.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2644.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2938.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11074.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGET GENOMIC ANALYSIS 51+", "code_information": [{"code": "81455", "type": "CPT"}, {"code": "7251006", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 2627.64, "maximum": 11074.04, "gross_charge": 9744.0, "discounted_cash": 7308.0, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2644.58, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2938.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11074.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2627.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MANAGEMENT", "code_information": [{"code": "T1017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MGMT PER MONTH", "code_information": [{"code": "T2023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TARGETED GENOMIC SEQ ANALYS", "code_information": [{"code": "81445", "type": "CPT"}, {"code": "7251445", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2267.87, "gross_charge": 5847.0, "discounted_cash": 4385.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 853.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 607.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 674.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2267.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 538.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 538.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 538.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 538.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 538.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TARGT SEQ ANLYS 5-50", "code_information": [{"code": "81450", "type": "CPT"}, {"code": "7251450", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 2880.9, "gross_charge": 6432.0, "discounted_cash": 4824.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 925.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 658.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 731.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2880.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2657.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TAVR OPEN AXIL", "code_information": [{"code": "4613363", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAVR PERC FEM", "code_information": [{"code": "4613361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAVR TRANS AORTIC", "code_information": [{"code": "4613370", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 111752.0, "discounted_cash": 83814.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAVR TRANSCAROTID APPROACH", "code_information": [{"code": "4614003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TB EYE CAN/INT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8177520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1292.0, "discounted_cash": 969.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB EYE DUCT", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "8177525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 702.0, "discounted_cash": 526.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB GASTROSTOMY REPLACEMENT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8177531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1981.0, "discounted_cash": 1485.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TB TEAR DUCT", "code_information": [{"code": "A4263", "type": "HCPCS"}, {"code": "8034791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.87, "maximum": 96.87, "gross_charge": 702.0, "discounted_cash": 526.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 96.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL IMMUN MEASURE", "code_information": [{"code": "86480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 235.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 120.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 139.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 72.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 235.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL SUSPENSION", "code_information": [{"code": "86481", "type": "CPT"}, {"code": "7256481", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 379.3, "gross_charge": 716.0, "discounted_cash": 537.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 145.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 169.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 63.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 70.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 379.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TRACH CUFF", "code_information": [{"code": "A7521", "type": "HCPCS"}, {"code": "8207304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 243.47, "maximum": 243.47, "gross_charge": 943.0, "discounted_cash": 707.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 243.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB TRACH FEN WO CUFF", "code_information": [{"code": "A7520", "type": "HCPCS"}, {"code": "8207324", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 245.71, "maximum": 5848.0, "gross_charge": 5848.0, "discounted_cash": 4386.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5848.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 245.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBG-THYROXINE BND GLOBLN", "code_information": [{"code": "84442", "type": "CPT"}, {"code": "7254442", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 56.06, "gross_charge": 303.0, "discounted_cash": 227.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 28.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", 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"outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 908.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M OXIDRONATE", "code_information": [{"code": "A9561", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.26, "maximum": 190.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 190.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M TETROFOSMIN", "code_information": [{"code": "A9502", "type": "HCPCS"}], "standard_charges": [{"minimum": 368.72, "maximum": 368.72, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 368.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2319.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 773.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "4613274", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"gross_charge": 141662.0, "discounted_cash": 106246.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "4613274", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"gross_charge": 141662.0, "discounted_cash": 106246.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1183.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 396.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4092.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 56012.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1702.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 300.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5348.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 471.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 1CHMBR LDLS PM RA", "code_information": [{"code": "824T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8219.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7397.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8219.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1798.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 600.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5239.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6710.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TCATH RETRV INTRAVASC FB+IMG", "code_information": [{"code": "4617197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 14242.0, "discounted_cash": 10681.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH RETRV INTRAVASC FB+IMG", "code_information": [{"code": "4917197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 15524.0, "discounted_cash": 11643.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX A/V NONCOR SUBS", "code_information": [{"code": "4917213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8697.0, "discounted_cash": 6522.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX CESSATION", "code_information": [{"code": "4617214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9741.0, "discounted_cash": 7305.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX CESSATION", "code_information": [{"code": "4917214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9020.0, "discounted_cash": 6765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR ART", "code_information": [{"code": "4617211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8073.0, "discounted_cash": 6054.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR ART", "code_information": [{"code": "4917211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8697.0, "discounted_cash": 6522.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR VEN", "code_information": [{"code": "4617212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7258.0, "discounted_cash": 5443.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TCATH TX INIT NONCOR VEN", "code_information": [{"code": "4917212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9020.0, "discounted_cash": 6765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1250.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1250.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 977.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 977.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 132.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 849.63, "maximum": 849.63, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 849.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 425.27, "maximum": 425.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 425.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 98.85, "maximum": 98.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"minimum": 482.13, "maximum": 482.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 482.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TDAP > 7YR VAC IJ", "code_information": [{"code": "90715", "type": "CPT"}, {"code": "5320147", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 145.29, "maximum": 145.29, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TDAP > 7YR VAC IJ", "code_information": [{"code": "90715", "type": "CPT"}, {"code": "5320147", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 145.29, "maximum": 145.29, "gross_charge": 280.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 127.56, "maximum": 127.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 127.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 196.1, "maximum": 196.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 196.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 0.89, "maximum": 145.88, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 145.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEAR FILM IMG UNI/BI W/I&R", "code_information": [{"code": "330T", "type": "CPT"}], "standard_charges": [{"minimum": 161.58, "maximum": 161.58, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 161.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AEROSOL", "code_information": [{"code": "A9567", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.9, "maximum": 91.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC99M ARCITUMOMAB", "code_information": [{"code": "A9568", "type": "HCPCS"}], "standard_charges": [{"minimum": 4684.36, "maximum": 4684.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4684.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE CONT/ASSESS/FUNC", "code_information": [{"code": "93318", "type": "CPT"}, {"code": "3213318", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 357.41, "maximum": 357.41, "gross_charge": 8209.0, "discounted_cash": 6156.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 357.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE CONT/ASSESS/FUNC", "code_information": [{"code": "93318", "type": "CPT"}, {"code": "3303318", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 357.41, "maximum": 357.41, "gross_charge": 8209.0, "discounted_cash": 6156.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 357.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEE W OR WO CM+PROBE PLCMT+RPT", "code_information": [{"code": "C8925", "type": "HCPCS"}, {"code": "4608925", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"gross_charge": 3382.0, "discounted_cash": 2536.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TEE W/INTRCARD THERAPY", "code_information": [{"code": "93355", "type": "CPT"}, {"code": "4603354", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 806.32, "gross_charge": 7142.0, "discounted_cash": 5356.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 806.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 269.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELAVANCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3095", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.73, "maximum": 26.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}, {"code": "6293014", "type": "CDM"}, {"code": "780", "type": "RC"}], "standard_charges": [{"minimum": 113.64, "maximum": 113.64, "gross_charge": 142.0, "discounted_cash": 106.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH INPT PHARM MGMT", "code_information": [{"code": "G0459", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 154.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 154.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN CPLX", "code_information": [{"code": "77307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 817.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 817.44, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 222.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 525.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 494.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 166.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 583.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 423.33, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 121.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 525.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 91.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 15MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 15MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311233", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311237", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 30MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311237", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 7.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311234", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMAZEPAM 7.5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311234", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 31.0, "discounted_cash": 23.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8700", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.07, "maximum": 1.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.46, "maximum": 39.46, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W FLAP", "code_information": [{"code": "D7293", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 12346.29, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12346.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 8119.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8119.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 309.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP OBTURATOR PROSTHESIS", "code_information": [{"code": "D5936", "type": "HCPCS"}], "standard_charges": [{"minimum": 2864.17, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2864.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPERATURE GRADIENT STUDIES", "code_information": [{"code": "93740", "type": "CPT"}], "standard_charges": [{"minimum": 28.18, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 28.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPLATE MANDBLR PREBNT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8136900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4505.0, "discounted_cash": 3378.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPORAL ARTERY PROCEDURE", "code_information": [{"code": "37609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 28872.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 739.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 369.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 112.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPORARY EXTERNAL PACING", "code_information": [{"code": "92953", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPORARY TEAR DUCT PLUG", "code_information": [{"code": "A4262", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.94, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMSIROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 117.56, "maximum": 117.56, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 117.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON ANKLE PRESUTURED", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4028822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14133.0, "discounted_cash": 10599.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON EXCISION PALM/FINGER", "code_information": [{"code": "26145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 27388.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1917.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 646.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING", "code_information": [{"code": "26476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2376.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 786.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON LNGTH UPR A/E EA TDN", "code_information": [{"code": "24305", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 18104.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2147.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 722.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON PATELL PRESHPE ALLOGRFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4028823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 32497.0, "discounted_cash": 24372.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TENDON SHORTENING", "code_information": [{"code": "26477", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2322.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSFER WITH GRAFT", "code_information": [{"code": "26492", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3412.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1135.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16137.33, "maximum": 34100.56, "estimated_discounted_cash": 94005.86, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20788.51, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17378.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16788.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16137.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27005.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34100.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9693.9, "maximum": 20484.65, "estimated_discounted_cash": 89622.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12415.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10439.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10085.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9693.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16222.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20484.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENECTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}, {"code": "5324431", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 580.76, "maximum": 580.76, "gross_charge": 742.0, "discounted_cash": 556.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENECTEPLASE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}, {"code": "5324431", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 580.76, "maximum": 580.76, "gross_charge": 742.0, "discounted_cash": 556.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENIPOSIDE, 50 MG", "code_information": [{"code": "Q2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 8283.76, "maximum": 8283.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8283.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS BICEPS TDN AT ELBW", "code_information": [{"code": "24340", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2210.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 753.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311245", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR 300MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311245", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR ALAFEN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311246", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 299.0, "discounted_cash": 224.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR ALAFEN 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311246", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 299.0, "discounted_cash": 224.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 77.19, "maximum": 325.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 86.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 95.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 325.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 77.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENOGLIDE PER SQ CM", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "4025526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS", "code_information": [{"code": "24332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2280.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 767.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2871.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 965.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENSION RING, VAC ERECT DEV", "code_information": [{"code": "L7902", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.83, "maximum": 66.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311250", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 2MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311251", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 2MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311251", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311252", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERAZOSIN 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311252", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBINAFINE 1% 12GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337426", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERBINAFINE 1% 12GM CR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337426", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TERBUTALINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311260", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311260", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.54, "maximum": 2.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7681", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.54, "maximum": 2.54, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE UPTO 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3105", "type": "HCPCS"}, {"code": "5324426", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 29.56, "maximum": 29.56, "gross_charge": 403.0, "discounted_cash": 302.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE UPTO 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3105", "type": "HCPCS"}, {"code": "5324426", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.56, "maximum": 29.56, "gross_charge": 403.0, "discounted_cash": 302.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERCONAZOLE 80MG VSU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337430", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 455.0, "discounted_cash": 341.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERCONAZOLE 80MG VSU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337430", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 455.0, "discounted_cash": 341.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERIPARATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 173.87, "maximum": 173.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 173.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}, {"code": "7251307", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 166.68, "maximum": 702.46, "gross_charge": 2673.0, "discounted_cash": 2004.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 167.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 186.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FECES FOR TRYPSIN", "code_information": [{"code": "84488", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.69, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 383.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 128.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR CHLOROHYDROCARBONS", "code_information": [{"code": "82441", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.95, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR PORPHOBILINOGEN", "code_information": [{"code": "84106", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 22.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.22, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 15.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR LACTOSE", "code_information": [{"code": "83633", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"standard_charge_dollar": 53.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE", "code_information": [{"code": "80198", "type": "CPT"}, {"code": "4172137", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.63, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311392", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 200MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311392", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311396", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE 300MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311396", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE100MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311408", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE100MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311408", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE200MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311409", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE200MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311409", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE300MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311410", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE300MG XR24CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311410", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE400MG XR24TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311405", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE400MG XR24TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311405", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE80MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316433", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE80MG/15ML LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316433", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 136.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER 15 MIN", "code_information": [{"code": "H2019", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.69, "maximum": 60.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 60.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER FX NASAL INF TURBINATE", "code_information": [{"code": "30930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 435.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 145.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER INDCTJ NTRABRN HYPTHRM", "code_information": [{"code": "776T", "type": "CPT"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER INJECTION CARP TUNNEL", "code_information": [{"code": "20526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 206.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 101.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 81.32, "estimated_discounted_cash": 361.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 81.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 77.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR CSF FLUOR/CT", "code_information": [{"code": "62329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 314.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER SPI PNXR DRG CSF", "code_information": [{"code": "62272", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 331.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 97.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 225.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 97.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 68.2, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERA PAR DRUGS 2 OR > ADMIN", "code_information": [{"code": "D9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 170.15, "maximum": 170.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ACTIVITIES", "code_information": [{"code": "97530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.42, "estimated_discounted_cash": 591.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC APHERESIS", "code_information": [{"code": "4540365", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"gross_charge": 9221.0, "discounted_cash": 6915.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THERAPEUTIC EXERCISES", "code_information": [{"code": "97110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 107.8, "estimated_discounted_cash": 594.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 326.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 154.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PULPOTOMY", "code_information": [{"code": "D3220", "type": "HCPCS"}], "standard_charges": [{"minimum": 302.53, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 302.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERAPY ACTIVATION IPNSS", "code_information": [{"code": "93150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 363.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 122.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN 4X6.5 PER SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025540", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 353.0, "discounted_cash": 264.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN 4X6.5 PER SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025540", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 353.0, "discounted_cash": 264.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN 6SQ CM XSML PR SQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025536", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 1063.0, "discounted_cash": 797.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN 6SQ CM XSML PR SQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025536", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 1063.0, "discounted_cash": 797.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN LRG 39SQ CM PR SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025535", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 262.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN LRG 39SQ CM PR SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025535", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 262.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN PER SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025532", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKIN PER SQ CM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025532", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKN XLG 7.6X15.2CM PRSQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025538", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THERASKN XLG 7.6X15.2CM PRSQCM", "code_information": [{"code": "Q4121", "type": "HCPCS"}, {"code": "4025538", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 170.69, "maximum": 170.69, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIAMINE 100MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5311471", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THIAMINE 100MG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5311471", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "THIAMINE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3411", "type": "HCPCS"}, {"code": "5324618", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 9.32, "maximum": 9.32, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIAMINE PER 100MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3411", "type": "HCPCS"}, {"code": "5324618", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.32, "maximum": 9.32, "gross_charge": 109.0, "discounted_cash": 81.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIAMINE(VITAMIN B1)", "code_information": [{"code": "84425", "type": "CPT"}, {"code": "7254423", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 80.53, "gross_charge": 355.0, "discounted_cash": 266.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 41.24, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 47.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 24.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3280", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.57, "maximum": 22.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 22.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE10MG", "code_information": [{"code": "Q0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.39, "maximum": 2.39, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIGH LENGTH SURG STOCKING", "code_information": [{"code": "A4495", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.74, "maximum": 15.74, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOCYANATE", "code_information": [{"code": "84430", "type": "CPT"}, {"code": "7254430", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.11, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIORIDAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311548", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIORIDAZINE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311548", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIORIDAZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311552", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIORIDAZINE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311552", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOTEPA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9340", "type": "HCPCS"}], "standard_charges": [{"minimum": 952.82, "maximum": 952.82, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 952.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOTHIXENE 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311583", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOTHIXENE 1MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311583", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOTHIXENE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311591", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIOTHIXENE 5MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311591", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5172.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1727.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5508.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1840.95, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "4912555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3512.0, "discounted_cash": 2634.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "5052555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3512.0, "discounted_cash": 2634.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACENTSIS W/IMAGING", "code_information": [{"code": "5062555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3512.0, "discounted_cash": 2634.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9726.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9726.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3245.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2117.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 711.69, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2896.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 976.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2468.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 825.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACIC W/SERL COMPLT", "code_information": [{"code": "75605", "type": "CPT"}, {"code": "4615605", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "gross_charge": 11287.0, "discounted_cash": 8465.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1070.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 136.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 777.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 863.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 247.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 81.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12752.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12752.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4259.42, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4394.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1470.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5701.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1906.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4232.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1434.18, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5408.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1807.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 761.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 253.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6307.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2108.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5932.48, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5932.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1984.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3787.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1270.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3916.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1311.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4787.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1601.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3426.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.62, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3039.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1016.85, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1095.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 367.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1640.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 550.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1346.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 450.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 913.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4985.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1667.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3203.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1072.46, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2864.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 958.17, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2881.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 966.36, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2403.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 804.65, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2638.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 883.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2566.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 859.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4339.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1451.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 554.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.28, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 554.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 184.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3118.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1044.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1703.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 569.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2852.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 946.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2647.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THORAX STEREO RAD TARGETW/TX", "code_information": [{"code": "32701", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 34839.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 31354.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34839.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 747.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 248.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1304.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1479.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2081.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1479.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1567.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1882.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2606.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1882.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1809.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 5007.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6120.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5007.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1925.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 643.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 326.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 140.89, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 106.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 262.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 292.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 326.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 106.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMB NONCOR ADD VESSLS", "code_information": [{"code": "4617185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17831.0, "discounted_cash": 13373.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR INITL VSL", "code_information": [{"code": "4617184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19280.0, "discounted_cash": 14460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR INITL VSL", "code_information": [{"code": "4914100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 19280.0, "discounted_cash": 14460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR SECONDARY", "code_information": [{"code": "4617186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17831.0, "discounted_cash": 13373.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMB NONCOR SECONDARY", "code_information": [{"code": "4914102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17831.0, "discounted_cash": 13373.25, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBIN 20000U SP KT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5337463", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 898.0, "discounted_cash": 673.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN 5000U BOV SP KT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5337479", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 803.0, "discounted_cash": 602.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN 5000U GELAT KT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5335701", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 491.0, "discounted_cash": 368.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN 5000U PW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5337467", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 998.0, "discounted_cash": 748.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN 5000U RECOM KT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}, {"code": "5337458", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "4105670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.89, "gross_charge": 240.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "4175670", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.89, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "7255616", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.89, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 25.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.32, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 816.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 273.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1367.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 457.38, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1760.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2969.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1193.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 400.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.51, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.98, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 36.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 18.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.17, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3055.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1015.99, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3063.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1018.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB TENDON TRANSFER", "code_information": [{"code": "26510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 17199.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2363.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 784.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3331.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 914.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": 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"standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "4124436", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.06, "gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "4154436", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.06, "gross_charge": 84.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "4174436", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 26.06, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 26.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311681", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311681", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 48.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311630", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIAGABINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311630", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 33.0, "discounted_cash": 24.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 701.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 639.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 937.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 639.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2590.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11298.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 13218.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11298.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1302.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3667.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4540.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3667.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 43274.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2440.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8404.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10066.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8404.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 17261.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2438.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8418.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 10072.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8418.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 22244.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1902.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 3682.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4679.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 3682.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBIA/FIBULA 2 VIEWS", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "4903590", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 90.01, "gross_charge": 2432.0, "discounted_cash": 1824.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 52.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 90.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2866.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 964.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3634.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBIAL KNEE TRY REVISION SN CL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4012888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 24525.0, "discounted_cash": 18393.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1134.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 754.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1221.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 754.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TICAGRELOR 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311675", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TICAGRELOR 60MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311675", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 72.0, "discounted_cash": 54.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TICAGRELOR 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311679", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TICAGRELOR 90MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311679", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 53.0, "discounted_cash": 39.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGECYCLINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3243", "type": "HCPCS"}, {"code": "5324739", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 2.79, "maximum": 2.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGECYCLINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3243", "type": "HCPCS"}, {"code": "5324739", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.79, "maximum": 2.79, "gross_charge": 15.0, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ABS W/BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2313.0, "discounted_cash": 1734.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE RT W/FLIPCUTR II/III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3355.0, "discounted_cash": 2516.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTRPE ACL RT DBL LD PAS SUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3822.0, "discounted_cash": 2866.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TILT TABLE SCAN PROC", "code_information": [{"code": "93660", "type": "CPT"}, {"code": "4601130", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 25806.0, "gross_charge": 6377.0, "discounted_cash": 4782.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 23224.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 25806.0, "methodology": "per diem"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 90.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIMOLOL .25% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332697", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIMOLOL .25% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332697", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 496.0, "discounted_cash": 372.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIMOLOL .5% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332707", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 242.0, "discounted_cash": 181.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIMOLOL .5% 2.5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332707", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 242.0, "discounted_cash": 181.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIMOLOL 0.5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332694", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIMOLOL 0.5% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332694", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 246.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 246.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 246.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINZAPARIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1655", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.57, "maximum": 14.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIROFIBAN PER .25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3246", "type": "HCPCS"}, {"code": "5324763", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 16.39, "maximum": 16.39, "gross_charge": 64.0, "discounted_cash": 48.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIROFIBAN PER .25MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3246", "type": "HCPCS"}, {"code": "5324763", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.39, "maximum": 16.39, "gross_charge": 64.0, "discounted_cash": 48.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3797.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1267.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1518.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 506.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 776.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3162.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1320.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L 10 SQ CM/<", "code_information": [{"code": "14060", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2427.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 941.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 111.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L10.1-30SQCM", "code_information": [{"code": "14061", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2984.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 191.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1222.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 191.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2277.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 932.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 146.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR F/C/C/M/N/A/G/H/F", "code_information": [{"code": "14041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2779.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 173.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1133.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 173.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10 SQ CM/<", "code_information": [{"code": "14020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2072.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 145.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 861.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 145.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10.1-30 SQCM", "code_information": [{"code": "14021", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2585.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1064.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 169.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10 SQ CM/<", "code_information": [{"code": "14000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1843.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 140.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 140.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR TRUNK 10.1-30SQCM", "code_information": [{"code": "14001", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2383.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 992.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 168.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISAGENLECLEUCEL CAR-POS T", "code_information": [{"code": "Q2042", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.55, "maximum": 12.55, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CONNECTIVE HUMAN", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "8240407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13919.0, "discounted_cash": 10439.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TISS CONNECTIVE N-HUMAN", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "8240409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 57083.0, "discounted_cash": 42812.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TISS CULT ADD STUDIES", "code_information": [{"code": "87253", "type": "CPT"}, {"code": "7257257", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 76.62, "gross_charge": 373.0, "discounted_cash": 279.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 39.23, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT INOC/OBSERV", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "7257227", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.88, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 58.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT INOC/OBSERV/2", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "7257084", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 98.88, "gross_charge": 483.0, "discounted_cash": 362.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 58.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 98.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CULT SOLID TUMOR", "code_information": [{"code": "88239", "type": "CPT"}, {"code": "7078241", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 559.54, "gross_charge": 1588.0, "discounted_cash": 1191.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 286.51, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 333.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 154.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 171.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 559.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 132.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS XPNDR PLMT BRST RCNSTJ", "code_information": [{"code": "19357", "type": "CPT"}], 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULT BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}, {"code": "7270070", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 545.24, 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"maximum": 3.79, "gross_charge": 102979.0, "discounted_cash": 77234.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE MATRIX ANY TYPE", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "4025531", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 102979.0, "discounted_cash": 77234.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN NON-RESORBABLE", "code_information": [{"code": "D6107", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN RESORBABLE", "code_information": [{"code": "D6106", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV INJ HM", "code_information": [{"code": "M0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 933.99, "maximum": 933.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 933.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV, 300MG", "code_information": [{"code": "Q0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV, 600MG", "code_information": [{"code": "Q0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIZANIDINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311694", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIZANIDINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311694", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIZANIDINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311692", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIZANIDINE 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311692", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL201 CHLORIDE 1MCI", "code_information": [{"code": "A9505", "type": "HCPCS"}, {"code": "5194800", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 141.21, "maximum": 141.21, "gross_charge": 1610.0, "discounted_cash": 1207.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 141.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2957.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 985.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250 G", "code_information": [{"code": "58572", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3710.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1269.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3329.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1107.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4458.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1483.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLSO TRPLNR MOD PREFB", "code_information": [{"code": "L0460", "type": "HCPCS"}, {"code": "8130983", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 4372.57, "maximum": 4372.57, "gross_charge": 2260.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4372.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM JOINTS UNILATERAL", "code_information": [{"code": "70328", "type": "CPT"}, {"code": "4900328", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 102.89, "gross_charge": 1360.0, "discounted_cash": 1020.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 92.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 102.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 110.06, "maximum": 606.69, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 110.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 122.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 606.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 143.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DEBRIDEMENT", "code_information": [{"code": "D7877", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4115.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISC REPOSIT", "code_information": [{"code": "D7874", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4004.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISCECTOMY", "code_information": [{"code": "D7876", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4448.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY LYSIS ADHESN", "code_information": [{"code": "D7873", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3169.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY SYNOVECTOMY", "code_information": [{"code": "D7875", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4282.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ASPIRATION JOINT FLUID", "code_information": [{"code": "D7870", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.3, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING INTO JOINT", "code_information": [{"code": "D7860", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3336.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING OF A MUSCLE", "code_information": [{"code": "D7856", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5450.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ DIAGNOSTIC ARTHROSCOPY", "code_information": [{"code": "D7872", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2892.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ EXCISN OF JOINT MEMBRANE", "code_information": [{"code": "D7854", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 11122.93, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11122.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MANIPULATION UNDER ANEST", "code_information": [{"code": "D7830", "type": "HCPCS"}], "standard_charges": [{"minimum": 1011.67, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1011.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MENISCECTOMY", "code_information": [{"code": "D7850", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 9120.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9120.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ OPEN REDUCT-DISLOCATION", "code_information": [{"code": "D7810", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 7006.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7006.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RECONSTRUCTION", "code_information": [{"code": "D7858", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 12457.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12457.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ REPAIR OF JOINT DISC", "code_information": [{"code": "D7852", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 10900.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10900.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RESHAPING COMPONENTS", "code_information": [{"code": "D7865", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 9342.88, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9342.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ UNSPECIFIED THERAPY", "code_information": [{"code": "D7899", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 212.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5434.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANOUS APPROACH", "code_information": [{"code": "4610483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7133.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TNOT OPN ELBW TO SHO EA TDN", "code_information": [{"code": "24310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1760.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 587.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBACCO COUNSELING", "code_information": [{"code": "D1320", "type": "HCPCS"}], "standard_charges": [{"minimum": 102.07, "maximum": 102.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYC/DEXAMETH2.5MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332734", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYC/DEXAMETH2.5MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332734", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 444.0, "discounted_cash": 333.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYC/DEXAMETH3.5GMOO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332731", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 998.0, "discounted_cash": 748.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYC/DEXAMETH3.5GMOO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332731", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 998.0, "discounted_cash": 748.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4104468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.18, "gross_charge": 476.0, "discounted_cash": 357.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4124468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.18, "gross_charge": 28.0, "discounted_cash": 21.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4154468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.18, "gross_charge": 195.0, "discounted_cash": 146.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "4174468", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 61.18, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 61.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN .3% 3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332725", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 774.0, "discounted_cash": 580.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN .3% 3.5GM OO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332725", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 774.0, "discounted_cash": 580.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN .3% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332726", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN .3% 5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332726", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 189.0, "discounted_cash": 141.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 1.2GM PW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337470", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 6297.0, "discounted_cash": 4722.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 300MG 5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332732", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 300MG 5ML IS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332732", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 922.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7682", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.66, "maximum": 82.66, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 82.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN UPTO 80MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3260", "type": "HCPCS"}, {"code": "5324780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 10.1, "maximum": 10.1, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN UPTO 80MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3260", "type": "HCPCS"}, {"code": "5324780", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 10.1, "maximum": 10.1, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB (COVID) PER 1MG IJ", "code_information": [{"code": "Q0249", "type": "HCPCS"}, {"code": "5324793", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 24.92, "maximum": 24.92, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}, {"code": "5324791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 23.21, "maximum": 23.21, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}, {"code": "5324791", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 23.21, "maximum": 23.21, "gross_charge": 26.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12368.06, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12368.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 4134.79, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOE(S) 2 VIEWS", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "4903660", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 104.74, "gross_charge": 792.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 47.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 94.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 104.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.41, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOILET RAIL", "code_information": [{"code": "E0243", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.0, "maximum": 132.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOILET SEAT RAISED", "code_information": [{"code": "E0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 100.51, "maximum": 100.51, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLNAFTATE 1% 120ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337490", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOLNAFTATE 1% 120ML SP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337490", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOLTERODINE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311751", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLTERODINE 1MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311751", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 34.0, "discounted_cash": 25.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLTERODINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311752", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLTERODINE 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311752", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 38.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLVAPTAN 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311730", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4722.0, "discounted_cash": 3541.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOLVAPTAN 15MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311730", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 4722.0, "discounted_cash": 3541.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 292.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 263.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 70.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 125.78, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 125.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 43.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7852.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2615.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1376.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 557.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1075.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 557.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10804.32, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10804.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3597.14, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7966.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2651.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8667.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2888.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9956.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3312.13, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2430.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 809.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1658.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 553.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH PIN RETENTION", "code_information": [{"code": "D2951", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.7, "maximum": 84.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOTH REIMPLANTATION", "code_information": [{"code": "D7270", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.26, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 802.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOTH ROOT REMOVAL", "code_information": [{"code": "D7250", "type": "HCPCS"}], "standard_charges": [{"minimum": 445.3, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 445.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOTH SPLITTING", "code_information": [{"code": "D3920", "type": "HCPCS"}], "standard_charges": [{"minimum": 636.5, "maximum": 636.5, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 636.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOTH TRANSPLANTATION", "code_information": [{"code": "D7272", "type": "HCPCS"}], "standard_charges": [{"minimum": 1113.21, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1113.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL APP FLUORID EX VRNSH", "code_information": [{"code": "D1208", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.24, "maximum": 46.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 46.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "D1206", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.3, "maximum": 58.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311755", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311755", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311754", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE 25MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311754", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPIRAMATE LVL", "code_information": [{"code": "80201", "type": "CPT"}, {"code": "7254470", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45.21, "gross_charge": 713.0, "discounted_cash": 534.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPOGRAPHIC BRAIN MAPPING", "code_information": [{"code": "S8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.96, "maximum": 2.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8705", "type": "HCPCS"}], "standard_charges": [{"minimum": 430.47, "maximum": 430.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 430.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311762", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSEMIDE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311762", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSEMIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORSEMIDE 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22856", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5909.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1979.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6347.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2132.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2ND LVL CRV", "code_information": [{"code": "22858", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1817.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 610.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2NTRSPC LMBR", "code_information": [{"code": "22860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1251.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 496.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 211.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 108.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 126.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 57.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 64.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 211.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 50.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 25273.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4678.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1570.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ARTHROPLASTY", "code_information": [{"code": "27132", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 43189.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6074.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2039.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3717.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1242.02, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4521.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1504.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ARTHROPLASTY", "code_information": [{"code": "27447", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 46034.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4671.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1569.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1210.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 403.68, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTAZOLINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2670", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 159.15, "maximum": 159.15, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 159.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOURNIQUET FOR DIALYSIS, EA", "code_information": [{"code": "A4929", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.21, "maximum": 1.21, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB", "code_information": [{"code": "86777", "type": "CPT"}, {"code": "7256773", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB IGM", "code_information": [{"code": "86778", "type": "CPT"}, {"code": "7256923", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.66, "gross_charge": 145.0, "discounted_cash": 108.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 441.6, "maximum": 2434.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 441.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 490.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2434.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 577.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 211.91, "maximum": 1168.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 211.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 235.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1168.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81352", "type": "CPT"}], "standard_charges": [{"minimum": 226.71, "maximum": 1249.83, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 226.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 251.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1249.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 296.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 663.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 175.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 419.55, "maximum": 1768.18, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 422.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 469.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1768.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN 2-1DEX AA 1L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5413010", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1203.0, "discounted_cash": 902.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN 2-1DEX AA 1L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5413010", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1203.0, "discounted_cash": 902.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN 3-1 DEX AA FAT 1L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412999", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1203.0, "discounted_cash": 902.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN 3-1 DEX AA FAT 1L", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412999", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1203.0, "discounted_cash": 902.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN NEONATAL 2-1 250ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412950", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1775.0, "discounted_cash": 1331.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN NEONATAL 2-1 250ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412950", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1775.0, "discounted_cash": 1331.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN NEONATAL 2-1 500ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412951", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3402.0, "discounted_cash": 2551.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPN NEONATAL 2-1 500ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5412951", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 3402.0, "discounted_cash": 2551.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 55.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 994.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 695.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL LSR ABLT B9 PRST8 HYPR", "code_information": [{"code": "714T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 10961.98, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 594.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3301.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4182.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1391.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 743.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 295.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1219.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 889.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOTOMY LSR W/OCT GDN", "code_information": [{"code": "730T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 945.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACE METAL 10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324849", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACE METAL 1ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324844", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 121.0, "discounted_cash": 90.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11219.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11219.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3757.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [{"code": "12", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45756.25, "maximum": 96689.74, "estimated_discounted_cash": 89055.36, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48504.57, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 49276.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47602.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 45756.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76570.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 96689.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [{"code": "11", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59193.35, "maximum": 125084.33, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 69027.92, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 63747.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 61582.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 59193.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 99057.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 125084.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC", "code_information": [{"code": "13", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31115.01, "maximum": 66091.2, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31115.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 33682.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32538.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31276.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 52339.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66091.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY SHOWER PROTECT", "code_information": [{"code": "A7523", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [{"code": "4", "type": "MS-DRG"}], "standard_charges": [{"minimum": 150329.24, "maximum": 317668.01, "estimated_discounted_cash": 556055.16, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 158121.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 161895.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 156396.16, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 150329.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 251569.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 317668.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAMADOL 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311769", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAMADOL 100MG XR TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311769", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 47.0, "discounted_cash": 35.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAMADOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311770", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAMADOL 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311770", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAMADOL QUANT", "code_information": [{"code": "80373", "type": "CPT"}, {"code": "7250373", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 232.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 650MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311805", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID 650MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311805", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3290", "type": "HCPCS"}, {"code": "5324874", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.07, "discounted_cash": 0.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANEXAMIC ACID PER 5MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3290", "type": "HCPCS"}, {"code": "5324874", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.07, "discounted_cash": 0.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANS CATH PLCMNT RMV CEPD", "code_information": [{"code": "4613337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17109.0, "discounted_cash": 12831.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4149.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1386.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4545.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1524.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1113.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 95.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 480.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 95.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "4104460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.1, "gross_charge": 499.0, "discounted_cash": 374.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "4124460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.1, "gross_charge": 11.0, "discounted_cash": 8.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "4154460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.1, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "4174460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.1, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSAMINASE-SGPT (ALT)", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "7254460", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 20.1, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSBRONCH LUNG BIOPSY", "code_information": [{"code": "5500665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1394.0, "discounted_cash": 1045.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE PVL AORTIC", "code_information": [{"code": "93591", "type": "CPT"}, {"code": "4613601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91499.25, "gross_charge": 121999.0, "discounted_cash": 91499.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 79299.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 48799.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3147.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 91499.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1059.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE PVL EA ADDL", "code_information": [{"code": "93592", "type": "CPT"}, {"code": "4613605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 45750.0, "gross_charge": 61000.0, "discounted_cash": 45750.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 39650.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 24400.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1380.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 45750.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE PVL MITRAL", "code_information": [{"code": "93590", "type": "CPT"}, {"code": "4613590", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91499.25, "gross_charge": 121999.0, "discounted_cash": 91499.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 79299.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 48799.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3826.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 91499.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1278.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE PVL MITRAL", "code_information": [{"code": "93590", "type": "CPT"}, {"code": "4613590", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91499.25, "gross_charge": 121999.0, "discounted_cash": 91499.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5496.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 79299.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 48799.6, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3826.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 91499.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1278.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 3848.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INS/RPL PERM LDLS PM", "code_information": [{"code": "4610387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 61053.0, "discounted_cash": 45789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6710.92, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6710.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5390.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4178.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1401.09, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3254.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1091.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3502.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1166.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3561.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 761.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 257.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8887.99, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8887.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2955.98, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10770.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10770.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3541.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSCRANIAL DOPP COMP", "code_information": [{"code": "93886", "type": "CPT"}, {"code": "4802060", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 831.46, "gross_charge": 1783.0, "discounted_cash": 1337.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 831.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 255.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD RF", "code_information": [{"code": "58580", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1459.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3246.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 35.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 35.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCYTE, PER SQ CENTIMETER", "code_information": [{"code": "Q4182", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.18, "maximum": 152.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 152.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"minimum": 201.33, "maximum": 702.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 201.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"minimum": 508.04, "maximum": 1769.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1769.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 508.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1677.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 560.92, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4968.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1660.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 340.76, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 340.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 113.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3054.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1026.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 544.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 768.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 312.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3559.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1195.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3316.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1114.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3199.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1074.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER SKIN PEDICLE FLAP", "code_information": [{"code": "15650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1478.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 662.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2565.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 863.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER TUB RAIL ATTACHMENT", "code_information": [{"code": "E0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 225.23, "maximum": 225.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 225.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "4104462", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.4, "gross_charge": 711.0, "discounted_cash": 533.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.8, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "4154462", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.4, "gross_charge": 152.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.8, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}], "billing_class": 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"HUMANA COMMERCIAL", "standard_charge_dollar": 48.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "4546430", "type": "CDM"}, {"code": "391", 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"plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 926.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 1736.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 2366.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1456.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2730.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFUSION BLD/BLD COMP", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "6293110", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "gross_charge": 3641.0, "discounted_cash": 2730.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 2366.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 1456.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 153.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 2730.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 51.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8669.38, "maximum": 18319.68, "estimated_discounted_cash": 85143.85, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10176.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9336.37, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9019.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8669.38, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14507.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 509.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 252.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2857.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 955.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLACE PROS", "code_information": [{"code": "55875", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2842.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 958.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10367.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3450.83, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9552.67, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9552.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3214.75, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3288.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1105.6, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25310", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2301.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 886.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25312", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2647.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 891.54, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT HAND TENDON", "code_information": [{"code": "26480", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 18837.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2892.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 887.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2286.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 769.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT PALM TENDON", "code_information": [{"code": "26485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3077.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1021.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3434.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1151.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3206.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1063.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3541.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1174.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17414.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17414.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5827.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17238.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17238.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5763.99, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8828.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2962.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10543.86, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3535.56, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19494.54, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19494.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 6540.37, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 2172.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3363.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1131.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 448.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 150.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 875.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 293.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 457.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 646.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 216.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORT X-RAY MULTIPL", "code_information": [{"code": "R0075", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 840.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE EKG", "code_information": [{"code": "R0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.4, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPORT PORTABLE X-RAY", "code_information": [{"code": "R0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 840.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3616.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1209.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2600.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 864.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSSEPTAL FIBEROTOMY", "code_information": [{"code": "D7291", "type": "HCPCS"}], "standard_charges": [{"minimum": 422.35, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 422.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8713.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2899.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "4104450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 396.0, "discounted_cash": 297.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "4124450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "4154450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 61.0, "discounted_cash": 45.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "4174450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTERASE AST(SGOT)", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "7254450", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.65, "gross_charge": 167.0, "discounted_cash": 125.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 10.04, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11.68, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3317.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1110.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4434.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1481.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4761.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1589.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16843.86, "maximum": 35593.57, "estimated_discounted_cash": 97397.83, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18447.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 18139.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17523.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16843.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 28187.42, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 35593.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31690.76, "maximum": 66967.28, "estimated_discounted_cash": 69831.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36406.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 34128.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 32969.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31690.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 53033.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 66967.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10606.64, "maximum": 22413.4, "estimated_discounted_cash": 75950.55, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13049.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11422.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11034.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10606.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17749.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22413.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16316.4, "maximum": 34478.98, "estimated_discounted_cash": 100299.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21602.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17571.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16974.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16316.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27304.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34478.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11475.96, "maximum": 24250.41, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11557.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12358.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11939.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11475.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19204.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24250.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6502.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 811.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2742.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 11524.08, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11524.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3849.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15976.7, "maximum": 33761.14, "estimated_discounted_cash": 54307.75, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18391.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17205.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16621.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15976.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26736.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33761.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [{"code": "605", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9941.35, "maximum": 21007.54, "estimated_discounted_cash": 59065.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11165.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10706.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10342.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9941.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16636.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21007.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16623.23, "maximum": 37487.92, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16623.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19105.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 18456.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17740.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 29687.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 37487.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9610.33, "maximum": 20308.06, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10211.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10349.72, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9998.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9610.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16082.45, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20308.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "86", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14138.2, "maximum": 29876.12, "estimated_discounted_cash": 64020.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16289.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15225.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14708.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14138.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 23659.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 29876.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "85", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24656.93, "maximum": 52103.75, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28802.91, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26553.97, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25652.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24656.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41262.25, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52103.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "87", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9927.24, "maximum": 20977.73, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10868.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10691.01, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10327.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9927.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16612.78, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 20977.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "83", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15148.62, "maximum": 32011.28, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18067.02, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16314.11, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15759.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15148.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25350.52, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32011.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "82", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24805.62, "maximum": 52417.95, "estimated_discounted_cash": 138691.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27887.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26714.09, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 25806.71, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24805.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 41511.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 52417.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "84", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10373.3, "maximum": 21920.32, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12517.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11171.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10791.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10373.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17359.24, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 21920.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAZADONE", "code_information": [{"code": "80338", "type": "CPT"}, {"code": "7250301", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 48.36, "gross_charge": 98.0, "discounted_cash": 73.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311795", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAZODONE 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311795", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAZODONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAZODONE 50MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5311791", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB AMPLIFICATION METHOD", "code_information": [{"code": "81340", "type": "CPT"}, {"code": "7040091", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 792.43, "gross_charge": 1463.0, "discounted_cash": 1097.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 406.31, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 471.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 167.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 185.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 792.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB AMPLIFICATION METHOD", "code_information": [{"code": "81340", "type": "CPT"}, {"code": "7251341", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 792.43, "gross_charge": 1594.0, "discounted_cash": 1195.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 406.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 471.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 167.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 185.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 792.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 188.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 188.09, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 96.44, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 39.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 44.09, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 188.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7124.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7124.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5549.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1856.84, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1764.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1453.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 487.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1831.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 614.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2675.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 894.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2899.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE FRACTURE", "code_information": [{"code": "28445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3846.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1286.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 469.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 180.36, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28495", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 561.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 228.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28496", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1021.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 238.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 612.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 238.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 791.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2885.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 966.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2528.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 849.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2596.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 874.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6288.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2114.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5119.3, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5119.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1721.54, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7395.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2486.01, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2212.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 906.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 159.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2295.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 935.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 154.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1010.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 339.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2979.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 989.63, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2980.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3456.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1148.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3279.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1090.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1527.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 507.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2890.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 960.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2827.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 938.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1290.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 480.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1784.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 597.61, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2630.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 884.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1768.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 295.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 127.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 25.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3977.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1331.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3983.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1336.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2190.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 736.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2496.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 843.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EYELID BY INJECTION", "code_information": [{"code": "68200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 123.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26770", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1814.8, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 999.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 370.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26775", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1343.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 44.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 503.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 44.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26785", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2034.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 687.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 723.14, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 259.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26725", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1764.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1154.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 436.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26727", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6502.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1772.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 595.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26735", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2207.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 742.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 840.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 300.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26742", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1264.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 474.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26746", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2738.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 922.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 726.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 243.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26755", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1758.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1038.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 411.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26765", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 18515.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1875.75, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 630.72, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT BONE LESION", "code_information": [{"code": "28005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2102.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 705.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 661.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 247.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1022.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 393.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1317.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 240.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 714.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 240.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 747.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1276.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 479.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1448.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 490.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 603.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 277.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1150.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1455.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 497.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOREARM BONE LESION", "code_information": [{"code": "25035", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2183.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 734.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 982.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 366.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1735.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 642.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 52.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2482.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 834.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2039.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 728.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2917.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 980.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3517.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1181.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 926.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 341.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 24.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1720.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 36417.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2316.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 779.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 987.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 3450.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1744.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 656.23, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS & ULNA", "code_information": [{"code": "25574", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2497.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 841.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3328.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1119.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1233.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 3990.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1915.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 681.56, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE ULNAR STYLOID", "code_information": [{"code": "25652", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2309.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 778.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX DISTAL RADIAL", "code_information": [{"code": "25606", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2480.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD EXTRA-ARTICUL", "code_information": [{"code": "25607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 38553.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2738.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 923.14, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RAD INTRA-ARTICUL", "code_information": [{"code": "25608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 19562.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3056.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1028.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX RADIAL 3+ FRAG", "code_information": [{"code": "25609", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "estimated_discounted_cash": 35944.52, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3870.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1303.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND BONE LESION", "code_information": [{"code": "26034", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2045.72, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 689.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1187.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 450.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1589.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 44.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 586.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 44.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2140.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 722.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26686", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2303.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 773.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HEEL FRACTURE", "code_information": [{"code": "28415", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4111.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1377.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 650.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 217.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2749.13, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 919.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3439.3, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1155.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4639.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1557.23, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 879.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 82.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 391.29, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 82.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1322.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4065.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1364.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5620.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1888.49, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1561.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27266", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2154.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 721.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6004.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2017.32, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6818.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2289.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1529.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 520.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3589.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3867.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1292.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1269.29, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 463.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4031.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1698.7, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 637.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 23734.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3236.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1087.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3152.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1058.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1331.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 488.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 35.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2141.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 783.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 55.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2912.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 974.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3408.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1146.27, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24546", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3800.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1278.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1119.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 425.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 41.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1857.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 684.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2666.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24575", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2706.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1193.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 449.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1903.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 704.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3073.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1034.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24582", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3018.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1015.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1757.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 644.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2350.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 790.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3200.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1073.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3805.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1276.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4324.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1451.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1097.5, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 393.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27532", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2153.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27535", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3274.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1099.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4340.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1458.08, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2990.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1006.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE(S)", "code_information": [{"code": "27538", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1687.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 37.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 610.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 37.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1288.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 473.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1828.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 616.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3276.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1100.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1141.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 416.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27524", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "estimated_discounted_cash": 25871.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2772.34, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 931.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1187.17, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 434.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1495.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 555.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26715", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2129.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 717.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1752.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 716.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 115.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21451", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2336.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 934.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 133.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1667.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 286.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 866.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 286.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21453", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3389.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 170.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1308.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 170.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1793.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 611.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21461", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3874.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 804.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2143.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 804.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21462", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4226.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 830.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2340.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 830.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2919.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 993.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4254.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1426.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG BONE LESION", "code_information": [{"code": "27607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2202.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 737.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1357.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 495.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1531.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 516.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2794.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 940.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27824", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1152.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 401.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1833.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 59.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 687.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 59.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3138.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1048.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27827", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4106.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1375.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27828", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4852.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1622.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG JOINT", "code_information": [{"code": "27829", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 14712.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2603.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 868.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26600", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1092.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 387.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26605", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1127.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 420.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1886.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 629.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26608", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1797.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 603.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2136.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 719.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 774.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 275.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28475", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 861.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 328.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28476", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1437.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 486.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28485", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 32126.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2083.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 696.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1380.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 461.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 721.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 21.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 267.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 21.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 856.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 320.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28465", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2366.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1990.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 792.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 105.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2279.44, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 776.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2903.69, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 972.86, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5521.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1849.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6688.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2239.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6039.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2018.4, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC FRACTURE(S)", "code_information": [{"code": "27215", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2216.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3274.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3079.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4221.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2906.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 974.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3406.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1142.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 272.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 185.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 185.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 937.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 340.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 20.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24655", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1533.13, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 570.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2432.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 819.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2700.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 908.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 384.31, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 149.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28531", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 673.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 153.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 399.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 153.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3793.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1271.96, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4657.27, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4657.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1559.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2452.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 824.82, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27176", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3383.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1137.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4081.99, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1371.14, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3383.36, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1137.05, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4098.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1376.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CANAL LESION", "code_information": [{"code": "62282", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 517.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 372.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62280", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 582.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 177.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 391.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 177.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 566.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 289.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5402.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1816.82, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 558.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5011.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2016.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 677.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 724.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 241.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1945.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 654.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1783.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 608.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2659.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 896.96, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3322.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1115.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27236", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4358.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1463.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1742.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 585.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3490.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1176.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4481.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1505.3, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27245", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1503.38, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1443.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 489.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2729.71, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 916.9, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27516", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1817.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 654.04, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2550.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 859.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3251.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1092.22, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THORAX SPINE FRACTURE", "code_information": [{"code": "22327", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5627.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1886.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB DISLOCATION", "code_information": [{"code": "26641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1861.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1443.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 533.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1488.18, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 549.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1796.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "estimated_discounted_cash": 37231.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2324.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 784.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 409.45, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 483.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 211.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28636", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 823.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 136.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 433.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 136.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 349.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 157.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 34.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28665", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 468.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 187.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28666", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 646.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 214.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE FRACTURE", "code_information": [{"code": "28525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1507.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 166.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 682.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 166.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3236.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1087.6, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4128.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1384.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1017.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 375.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1570.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 581.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2419.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 812.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1698.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 562.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 93.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 68.35, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 444.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 81.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1080.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 395.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25624", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1678.29, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.14, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 624.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 55850.56, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2655.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 894.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 30454.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1079.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 392.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 23.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25635", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1595.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 592.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25645", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2117.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 712.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25650", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1160.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 421.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1686.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2248.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 754.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25675", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1805.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1555.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 48.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 582.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 48.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2336.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25690", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1842.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 619.03, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25695", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2345.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 788.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1982.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 667.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25685", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2711.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4747.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1590.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 271.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 89.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 530.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 128.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 321.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 128.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 476.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 130.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 304.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 130.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27786", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1087.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 398.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27788", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1447.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 44.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 538.16, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 44.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "estimated_discounted_cash": 16986.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2378.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 796.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27808", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1159.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 429.12, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 32.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27810", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1606.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 599.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27814", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2810.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 942.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1115.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 422.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 40.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27818", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1650.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 623.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27822", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3209.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1071.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27823", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3612.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1207.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 794.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 303.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1235.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 469.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 45.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28436", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1845.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 617.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BLADDER LESION", "code_information": [{"code": "51720", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 47.56, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 108.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 47.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BONE CYST", "code_information": [{"code": "20615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 595.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 301.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1805.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 637.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF COMPLICATIONS", "code_information": [{"code": "D9930", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.53, "maximum": 115.53, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 115.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1176.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 401.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 172.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 76.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27780", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1080.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 395.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27781", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1518.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 38.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 554.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27784", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2636.63, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 878.57, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 512.28, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 295.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 110.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 941.46, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 125.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 455.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 125.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 446.55, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5620.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5620.28, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1881.59, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 867.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 313.67, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1520.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.07, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 570.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28406", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2188.26, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 733.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1125.72, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 438.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1384.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 57.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 524.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 57.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 608.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 308.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 96.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2278.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 764.06, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1564.88, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 563.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 31.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 143.63, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 31.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1947.48, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 652.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1784.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 488.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 93.7, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 270.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 93.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 148.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 126.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2089.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 725.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1805.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 620.52, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 4484.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5020.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1670.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2574.42, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 862.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3522.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1180.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1785.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 46.49, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 652.97, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 46.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1847.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 629.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27502", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2767.11, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 929.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2939.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 988.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4885.54, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1640.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3531.74, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1187.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1856.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 30.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 659.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 30.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27509", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2491.55, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 835.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27510", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2513.96, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 841.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27511", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3631.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1217.61, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4491.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1506.57, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3522.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1183.19, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1223.43, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 443.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27752", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1828.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 671.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 50.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27756", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2138.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 732.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27758", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3290.58, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1105.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27759", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8220.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5011.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 3392.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3702.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3649.25, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1226.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 0.35, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 455.62, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 153.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28515", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 541.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.39, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1654.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 554.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 254.81, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 27.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 20475.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 689.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 280.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 43.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1095.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 409.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 39.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB", 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"standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB", "code_information": [{"code": "86780", "type": "CPT"}, {"code": "4176002", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.22, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AB", "code_information": [{"code": "86780", "type": "CPT"}, {"code": "7256650", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.22, "gross_charge": 131.0, "discounted_cash": 98.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 46.2, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"minimum": 1034.81, "maximum": 5761.79, "setting": "outpatient", "payers_information": [{"payer_name": 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIIODTHYRNINE TOTAL T3", "code_information": [{"code": "84480", "type": "CPT"}, {"code": "7253539", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 53.78, "gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.5, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 29.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 17.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAILS ANY NUMBER", "code_information": [{"code": "6900035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM NAILS ANY NUMBER", "code_information": [{"code": "6900035", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 197.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION 2-4", "code_information": [{"code": "6900071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1745.0, "discounted_cash": 1308.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION 2-4", "code_information": [{"code": "6900071", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1745.0, "discounted_cash": 1308.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION SINGLE", "code_information": [{"code": "6900070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIM SKIN LESION SINGLE", "code_information": [{"code": "6900070", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.0, "discounted_cash": 1105.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL 250MG", "code_information": [{"code": "Q0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.19, "maximum": 3.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3250", "type": "HCPCS"}], "standard_charges": [{"minimum": 181.45, "maximum": 181.45, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 181.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE300MGCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312028", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE300MGCP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312028", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOPRIM 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312050", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOPRIM 100MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312050", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHPRM/POLYMYX10MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332760", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 314.0, "discounted_cash": 235.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHPRM/POLYMYX10MLOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332760", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 314.0, "discounted_cash": 235.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIPTORELIN PAMOATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3315", "type": "HCPCS"}], "standard_charges": [{"minimum": 1568.73, "maximum": 1568.73, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1568.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRISMUS APPLIANCE", "code_information": [{"code": "D5937", "type": "HCPCS"}], "standard_charges": [{"minimum": 947.45, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 947.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST ART", "code_information": [{"code": "37246", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 24432.75, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1229.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1505.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2067.48, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1505.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST VEIN", "code_information": [{"code": "37248", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "estimated_discounted_cash": 14028.7, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1052.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1085.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1548.99, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1085.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL ART", "code_information": [{"code": "37247", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 612.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 428.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 702.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 428.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP ADDL VEIN", "code_information": [{"code": "37249", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 15369.83, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 514.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 305.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 514.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 305.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2263.51, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 752.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2628.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 872.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 21276.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21276.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2231.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2818.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8422.05, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7232.53, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7232.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN 1ST 2 L/S", "code_information": [{"code": "64628", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1506.62, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 501.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN EA ADDL", "code_information": [{"code": "64629", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 712.59, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 236.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH BIOPSY", "code_information": [{"code": "4918005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 17384.0, "discounted_cash": 13038.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRNSCTH BIOPSY S&I", "code_information": [{"code": "75970", "type": "CPT"}, {"code": "4915971", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 14034.0, "discounted_cash": 10525.5, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 41.39, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 100.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH EMBOLIZATN", "code_information": [{"code": "75894", "type": "CPT"}, {"code": "4915895", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 254.68, "gross_charge": 18036.0, "discounted_cash": 13527.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 87.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 229.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 254.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 212.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1194.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 963.42, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 1894.31, "maximum": 10443.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1894.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2104.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10443.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2477.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 2173.77, "maximum": 11983.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2173.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2415.41, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11983.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2843.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 440.83, "maximum": 2430.29, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 440.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 489.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2430.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 440.83, "maximum": 2430.29, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 440.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 489.84, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2430.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 576.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRNSVN INTRHEP PORT SHNT", "code_information": [{"code": "4917182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 57810.0, "discounted_cash": 43357.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3927.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1316.46, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TROLAMINE SALIC10%60GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337651", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROLAMINE SALIC10%60GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337651", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROLAMINE SALIC10%90GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337652", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROLAMINE SALIC10%90GMCR", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5337652", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROMETHAMINE18GM/500MLIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5324965", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1405.0, "discounted_cash": 1053.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPICAMIDE .5% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332774", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPICAMIDE 1% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332781", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPICAMIDE 1% 2ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332780", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 133.0, "discounted_cash": 99.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPICAMIDE 1% 3ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332782", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 62.0, "discounted_cash": 46.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUAN", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "4104484", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.3, "gross_charge": 1264.0, "discounted_cash": 948.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUAN", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "4124484", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.3, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 19.11, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUAN", 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"plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, 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[{"code": "J3490", "type": "HCPCS"}, {"code": "5332790", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 741.0, "discounted_cash": 555.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPAN BLUE .15% .5ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332791", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1100.0, "discounted_cash": 825.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRYPS/BALS/CASTOR1APP OI", "drug_information": 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15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSH", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "4154443", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.72, "gross_charge": 201.0, "discounted_cash": 150.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TSH", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "4174443", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.72, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.94, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTE W/O DOPPLER COMPLETE", "code_information": [{"code": "93307", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 341.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 341.18, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}, {"code": "4610032", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27939.0, "gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 24213.8, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "standard_charge_dollar": 7450.4, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 11175.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 14900.8, "methodology": "fee schedule"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5567.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 27939.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 24213.8, "methodology": "fee schedule"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 7450.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}, {"code": "4610032", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 27939.0, "gross_charge": 37252.0, "discounted_cash": 27939.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "standard_charge_dollar": 24213.8, "methodology": "fee schedule"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "standard_charge_dollar": 7450.4, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "standard_charge_dollar": 11175.6, "methodology": "fee schedule"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "standard_charge_dollar": 14900.8, "methodology": "fee schedule"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5567.52, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "standard_charge_dollar": 27939.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "standard_charge_dollar": 18626.0, "methodology": "fee schedule"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "standard_charge_dollar": 24213.8, "methodology": "fee schedule"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 13038.2, "methodology": "fee schedule"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 7450.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "standard_charge_dollar": 9313.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3544.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR EA ADDL PROSTH", "code_information": [{"code": "4610570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 21096.0, "discounted_cash": 15822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR INITIAL PROSTH", "code_information": [{"code": "4610569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 40232.0, "discounted_cash": 30174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18581.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20646.0, "methodology": "per diem"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1772.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TUB STOOL OR BENCH", "code_information": [{"code": "E0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.69, "maximum": 164.69, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 164.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBERCULIN PPD 5TU IJ", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "5324989", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 37.4, "gross_charge": 383.0, "discounted_cash": 287.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 258.87, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUMOR IMM PER SPEC COMPT", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "7258361", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 280.8, "gross_charge": 630.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 135.91, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 181.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 71.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR IMM PER SPEC COMPT", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "7270090", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 280.8, "gross_charge": 579.0, "discounted_cash": 434.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 135.91, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 181.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 64.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 71.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.51, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 262.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR IMM PER SPEC MAN", "code_information": [{"code": "88360", "type": "CPT"}, {"code": "4300083", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 291.68, "gross_charge": 911.0, "discounted_cash": 683.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 77.44, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 133.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 47.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 52.69, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 291.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 95.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 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HEALTHCARE EXCHANGE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1305.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1713.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 576.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"minimum": 683.15, "maximum": 2879.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 687.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 763.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2879.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 683.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 187.91, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 263.16, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 369.93, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 177.82, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 403.88, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 196.69, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 77.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"TX PLN MAG FLD ABLTJ PRST8", "code_information": [{"code": "738T", "type": "CPT"}], "standard_charges": [{"minimum": 246.66, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 246.66, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN SMPL CLSR", "code_information": [{"code": "12020", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 4303.25, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 687.37, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 117.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 362.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 117.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN W/PACKING", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 214.28, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", 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"plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 5.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY & REFLEX THRESH", "code_information": [{"code": "92550", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 79.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 79.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYMS GENE COM VARIANTS", "code_information": [{"code": "81346", "type": "CPT"}], "standard_charges": [{"minimum": 157.33, "maximum": 663.05, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 158.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 175.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 663.05, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 157.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE IM", "code_information": [{"code": "90691", "type": "CPT"}], "standard_charges": [{"minimum": 469.12, "maximum": 469.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 469.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE ORAL", "code_information": [{"code": "90690", "type": "CPT"}], "standard_charges": [{"minimum": 408.62, "maximum": 408.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 408.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYROSINEMIA TYP I MNTR QUAN", "code_information": [{"code": "383U", "type": "CPT"}], "standard_charges": [{"minimum": 46.85, "maximum": 46.85, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 46.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tau, 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{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1876.85, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14984.74, "maximum": 31664.97, "estimated_discounted_cash": 125332.16, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19252.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16137.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15589.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 14984.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25076.27, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31664.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9277.14, "maximum": 19603.98, "estimated_discounted_cash": 59494.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12398.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9990.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9651.55, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9277.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15524.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19603.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLIS PROC BASILICA", "code_information": [{"code": "4613399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3846.0, "discounted_cash": 2884.5, "setting": "both", "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX SKN MUC MEMB SUBQ", "code_information": [{"code": "17999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED AMBULANCE SERVICE", "code_information": [{"code": "A0999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ANES PROCEDURE", "code_information": [{"code": "1999", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMOTHERAPY PX", "code_information": [{"code": "96549", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CT PROCEDURE", "code_information": [{"code": "76497", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 80.9, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 1402.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1261.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1402.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIALYSIS PROCEDURE", "code_information": [{"code": "90999", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 205.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED E&M SERVICE", "code_information": [{"code": "99499", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 667.4, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 600.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 667.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUOROSCOPIC PX", "code_information": [{"code": "76496", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 392.3, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 353.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 392.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 1134.3, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1020.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1134.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 1490.31, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1341.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1490.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 4.37, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HOME VISIT SVC/PX", "code_information": [{"code": "99600", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTSC PX UTERUS", "code_information": [{"code": "58579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 4.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BLADDER", "code_information": [{"code": "51999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ESOPH", "code_information": [{"code": "43289", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX INTESTINE", "code_information": [{"code": "44238", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LIVER", "code_information": [{"code": "47379", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [{"code": "58679", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "estimated_discounted_cash": 20506.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX TESTIS", "code_information": [{"code": "54699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX UTERUS", "code_information": [{"code": "58578", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4922.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 233.89, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 210.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 233.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 4.37, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PROSTHETIC SER", "code_information": [{"code": "L8499", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLEC PROC/2", "code_information": [{"code": "81479", "type": "CPT"}, {"code": "7251482", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 109.48, "gross_charge": 1535.0, 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"maximum": 1134.52, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1021.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1134.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", 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"plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 901.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED OPH SVC/PROCEDURE", "code_information": [{"code": "92499", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 2172.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PHYSCL MED/REHAB PX", "code_information": [{"code": "97799", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PREVENTIVE SERVICE", "code_information": [{"code": "99429", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ANUS", "code_information": [{"code": "46999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE BREAST", "code_information": [{"code": "19499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 7729.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4215.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4685.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EYELIDS", "code_information": [{"code": "67999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE NOSE", "code_information": [{"code": "30999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SHOULDER", "code_information": [{"code": "23929", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SPINE", "code_information": [{"code": "22899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE STOMACH", "code_information": [{"code": "43999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PSYC SVC/THERAPY", "code_information": [{"code": "90899", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABD PERTM&OMN", "code_information": [{"code": "49999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABDOMEN MUSCSKEL", "code_information": [{"code": "22999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ACCESSORY SINUS", "code_information": [{"code": "31299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ANT SEGMENT EYE", "code_information": [{"code": "66999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ARTHROSCOPY", "code_information": [{"code": "29999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 13611.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 111926.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1386.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1247.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1386.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DENTALVLR STRUX", "code_information": [{"code": "41899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXC PRESSURE ULC", "code_information": [{"code": "15999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTERNAL EAR", "code_information": [{"code": "69399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FEMUR/KNEE", "code_information": [{"code": "27599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FML GENITAL SYS", "code_information": [{"code": "58999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOOT/TOES", "code_information": [{"code": "28899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOREARM/WRIST", "code_information": [{"code": "25999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HANDS/FINGERS", "code_information": [{"code": "26989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HUMERUS/ELBOW", "code_information": [{"code": "24999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LEG/ANKLE", "code_information": [{"code": "27899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MALE GENITAL SYS", "code_information": [{"code": "55899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 471.97, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 424.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 471.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 10749.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MIDDLE EAR", "code_information": [{"code": "69799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MUSCSKEL GENERAL", "code_information": [{"code": "20999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 29473.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NERVOUS SYSTEM", "code_information": [{"code": "64999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 14403.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PALATE UVULA", "code_information": [{"code": "42299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PELVIS/HIP JOINT", "code_information": [{"code": "27299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PHRNX ADND/TNSL", "code_information": [{"code": "42999", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SMALL INTESTINE", "code_information": [{"code": "44799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 990.19, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 891.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 990.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 471.97, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 424.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 471.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX URINARY SYSTEM", "code_information": [{"code": "53899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR SURGERY", "code_information": [{"code": "37799", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 47528.5, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 17.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 34.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 38.32, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 946.48, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 851.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 946.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPEC DERM SVC/PX", "code_information": [{"code": "96999", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SPECIAL SVC PX/RPRT", "code_information": [{"code": "99199", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 44.78, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION MED PX", "code_information": [{"code": "86999", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 22.2, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 4.37, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VACCINE/TOXOID", "code_information": [{"code": "90749", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 3.79, "maximum": 1185.02, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1066.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1185.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX ABD PERTM&OMN", "code_information": [{"code": "49329", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "estimated_discounted_cash": 46001.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX HRNAP HRNRPHY", "code_information": [{"code": "49659", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA NAP", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA SIGNATURE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX SPRMATIC CORD", "code_information": [{"code": "55559", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7729.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 7161.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIAL ESRD PT", "code_information": [{"code": "G0257", "type": "HCPCS"}, {"code": "5600257", "type": "CDM"}, {"code": "809", "type": "RC"}], "standard_charges": [{"gross_charge": 6429.0, "discounted_cash": 4821.75, "setting": "both", "billing_class": "facility"}]}, {"description": "UNSCHED DIAL ESRD PT", "code_information": [{"code": "G0257", "type": "HCPCS"}, {"code": "5600257", "type": "CDM"}, {"code": "829", "type": "RC"}], "standard_charges": [{"gross_charge": 6429.0, "discounted_cash": 4821.75, "setting": "both", "billing_class": "facility"}]}, {"description": "UNSCHEDULED DRESSING CHANGE", "code_information": [{"code": "D4920", "type": "HCPCS"}], "standard_charges": [{"minimum": 106.47, "maximum": 106.47, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 106.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSPEC MAXILLOFACIAL PROSTH", "code_information": [{"code": "L8048", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED DIAGNOSTIC PROCE", "code_information": [{"code": "D0999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED PERIODONTAL PROC", "code_information": [{"code": "D4999", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNUSUAL PHYSICIAN TRAVEL", "code_information": [{"code": "99082", "type": "CPT"}], "standard_charges": [{"minimum": 105.75, "maximum": 105.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 2201.69, "maximum": 12137.6, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2201.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12137.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16664.0, "estimated_discounted_cash": 25563.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 13599.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14997.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16664.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9581.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1709.09, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 571.76, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY INFANT", "code_information": [{"code": "73092", "type": "CPT"}, {"code": "4903092", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 108.97, "gross_charge": 908.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 31.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 89.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 99.23, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 87.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY PROSTHES NOS", "code_information": [{"code": "L7499", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER GI DOUBLE CM STDY", "code_information": [{"code": "74246", "type": "CPT"}, {"code": "4904244", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 428.05, "gross_charge": 2857.0, "discounted_cash": 2142.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 191.15, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 152.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 385.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 428.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 352.26, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 114.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER GI W/SNGL CM STDY", "code_information": [{"code": "74240", "type": "CPT"}, {"code": "4904242", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 352.75, "gross_charge": 2750.0, "discounted_cash": 2062.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 163.57, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 129.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 317.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 308.64, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 178.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [{"code": "256", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18427.31, "maximum": 38939.64, "estimated_discounted_cash": 95419.62, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24746.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 19845.06, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19170.99, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18427.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30837.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 38939.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "255", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29274.88, "maximum": 61862.17, "estimated_discounted_cash": 169765.13, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37953.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31527.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30456.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 29274.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 48990.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 61862.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "257", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11853.65, "maximum": 25048.51, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15381.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12765.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12332.03, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE 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[{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2182.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 499.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 276.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 474.68, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 276.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 23.63, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337687", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA 20% 90GM CR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337687", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3350", "type": "HCPCS"}], "standard_charges": [{"minimum": 337.12, "maximum": 337.12, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 337.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19.46, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN URINE", "code_information": [{"code": "84540", "type": "CPT"}, {"code": "7254540", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 21.09, "gross_charge": 147.0, "discounted_cash": 110.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UREA-N CLEARANCE TEST", "code_information": [{"code": "84545", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 27.31, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.67, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 27.31, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY", "code_information": [{"code": "50970", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1330.21, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 446.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50955", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1265.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 83.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 523.73, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 83.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1697.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & CATHETER", "code_information": [{"code": "50972", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1284.01, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 431.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50957", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1271.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 528.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 86.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50961", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1139.87, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 473.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 80.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50976", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1673.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 561.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50980", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1277.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 428.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 631.19, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1692.6, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2131.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1692.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 870.81, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 291.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 329.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 783.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 669.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19481.13, "maximum": 41166.53, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23558.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20979.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20267.34, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19481.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32600.79, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41166.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11715.81, "maximum": 24757.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12377.82, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12617.2, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12188.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11715.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19605.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24757.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11697.36, "maximum": 24718.27, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 13445.73, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12597.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12169.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11697.36, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 19575.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24718.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHRLYS TRANSVAG W/ SCOPE", "code_information": [{"code": "53500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6480.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2726.9, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 911.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHROCYSTOGRAPHY RETR", "code_information": [{"code": "74450", "type": "CPT"}, {"code": "4904450", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 5.54, "maximum": 295.79, "gross_charge": 2400.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 266.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROCYSTOGRAPHY VOID", "code_information": [{"code": "74455", "type": "CPT"}, {"code": "4904455", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 349.07, "gross_charge": 3533.0, "discounted_cash": 2649.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 107.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 314.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 349.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 104.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 230.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHROCYSTOGRAPHY VOID", "code_information": [{"code": "74455", "type": "CPT"}, {"code": "4914455", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 349.07, "gross_charge": 3533.0, "discounted_cash": 2649.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 107.88, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 314.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 349.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.95, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY REFLEX STUDY", "code_information": [{"code": "51792", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": 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{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 237.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": 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11.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE PREG TEST QUAL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "4151026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.66, "gross_charge": 76.0, "discounted_cash": 57.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE PREG TEST QUAL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "4171026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.66, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE PREG TEST QUAL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "4181026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.66, "gross_charge": 367.0, "discounted_cash": 275.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE REAGENT STRIPS/TABLETS", "code_information": [{"code": "A4250", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.37, "maximum": 42.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 113.71, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2.67, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4441.03, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1489.11, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROFOLLITROPIN, 75 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 484.18, "maximum": 484.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 484.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROG/PYELOGRAPHY RETRO", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "4904420", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 541.95, "gross_charge": 3403.0, "discounted_cash": 2552.25, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 487.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 541.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 196.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROG/PYELOGRAPHY RETRO", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "4914420", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 541.95, "gross_charge": 2019.0, "discounted_cash": 1514.25, "setting": "both", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 487.73, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 541.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 196.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 64.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 368.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY IV +-KUB TOMOG", "code_information": [{"code": "74400", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 407.86, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 192.14, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 140.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 367.05, "methodology": 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"standard_charge_dollar": 190.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 676.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 751.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE NEEDLE PLACEMNT", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "5066960", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 751.44, "gross_charge": 3717.0, "discounted_cash": 2787.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 190.16, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 45.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 676.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 751.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 35.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US GUIDE VASCULAR ACCESS", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "4916937", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.82, "gross_charge": 3717.0, "discounted_cash": 2787.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 82.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 91.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 30.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": 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"CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6680.76, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US NRV&ACC STRUX 1XTR COMPRE", "code_information": [{"code": "76883", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 106.88, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 46.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 51.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 106.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 106.88, "methodology": "fee 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"standard_charge_dollar": 37.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.45, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 76.32, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 25.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP<14WKS 1STGEST", "code_information": [{"code": "76801", "type": "CPT"}, {"code": "5066801", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 385.77, "gross_charge": 1074.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 218.74, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 122.12, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 347.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 385.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.77, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP>14WK ADD GEST", "code_information": [{"code": "76810", "type": "CPT"}, {"code": "5066843", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 231.46, "gross_charge": 1087.0, "discounted_cash": 815.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 132.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 73.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 208.31, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 231.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 150.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 48.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB COMP>14WK SGL GEST", "code_information": [{"code": "76805", "type": "CPT"}, {"code": "5066825", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 468.46, "gross_charge": 1237.0, "discounted_cash": 927.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 231.56, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 152.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 468.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 323.01, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 105.21, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US OB F/U PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}, {"code": "5066826", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 345.39, "gross_charge": 1179.0, "discounted_cash": 884.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 139.91, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 119.15, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 310.84, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 345.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 254.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 82.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE EA ADDL TARGET LESION", "code_information": [{"code": "76983", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.23, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR 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"setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 379.45, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 127.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE PARENCHYMA", "code_information": [{"code": "76981", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 873.33, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 785.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 873.33, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 277.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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OPTIONS", "standard_charge_dollar": 42079.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "743", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13465.32, "maximum": 28454.21, "estimated_discounted_cash": 236924.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 14501.98, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 14501.3, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 14008.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13465.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22533.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 28454.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [{"code": "740", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19639.59, "maximum": 41501.37, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 23410.93, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21150.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20432.19, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19639.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 32865.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41501.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [{"code": "739", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38884.13, "maximum": 82167.94, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 48271.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41875.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40453.39, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38884.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 65070.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 82167.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "741", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15477.46, "maximum": 32706.18, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 17258.44, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16668.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16102.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15477.46, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 25900.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 32706.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [{"code": "737", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22363.69, "maximum": 47257.8, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29426.47, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24084.29, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 23266.23, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22363.69, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 37424.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 47257.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [{"code": "736", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38794.05, "maximum": 81977.58, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 64600.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 41778.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 40359.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 38794.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 64920.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 81977.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "738", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15937.63, "maximum": 33678.58, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 18569.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17163.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16580.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15937.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26670.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 33678.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ultrasound Follow-Up Study", "code_information": [{"code": "76970", "type": "CPT"}], "standard_charges": [{"minimum": 121.52, "maximum": 257.7, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 121.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 257.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Ultrasound Measurement Of Bone Density In Shin Bone", "code_information": [{"code": "508T", "type": "CPT"}], "standard_charges": [{"minimum": 36.19, "maximum": 36.19, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 36.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 16283.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 8718.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11030.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16283.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4210.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VABRA ASPIRATOR", "code_information": [{"code": "A4480", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.1, "maximum": 12.1, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"minimum": 293.43, "maximum": 293.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 293.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAD RAMP STUDY W/IMPELL DVC", "code_information": [{"code": "93799", "type": "CPT"}, {"code": "4619375", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 3.79, "gross_charge": 955.0, "discounted_cash": 716.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4205.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1399.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4542.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1510.88, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCLUDING T/O", "code_information": [{"code": "58262", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3395.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1129.84, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4786.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1591.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE COMPL", "code_information": [{"code": "58294", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4445.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1478.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE REPAIR", "code_information": [{"code": "58270", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3272.68, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1089.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/T/O & VAG REPAIR", "code_information": [{"code": "58263", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3638.47, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1211.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3913.12, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1301.11, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18852.75, "maximum": 39838.65, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 20715.66, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 20303.22, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 19613.6, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 18852.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31549.21, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 39838.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9330.32, "maximum": 19716.36, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12954.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10048.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9706.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9330.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15613.87, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19716.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C", "code_information": [{"code": "768", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.07, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC", "code_information": [{"code": "797", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.0, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC", "code_information": [{"code": "796", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.17, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.17, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC", "code_information": [{"code": "798", "type": "MS-DRG"}], "standard_charges": [{"minimum": 0.96, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE 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"methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.75, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [{"code": "805", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1.08, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC", "code_information": [{"code": "807", "type": "MS-DRG"}], "standard_charges": [{"minimum": 0.67, "maximum": 11996.0, "setting": "inpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 9844.0, "methodology": "case rate"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8767.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 8130.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 9033.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9940.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 6113.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 6066.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 5830.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 9499.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11996.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58260", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3073.2, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1022.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6343.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6343.19, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2115.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4321.36, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1448.88, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4370.9, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1465.03, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALACYCLOVIR 500MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312258", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 65.0, "discounted_cash": 48.75, "setting": "both", "payers_information": 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[{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6824.21, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2288.23, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12646.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8086.98, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 12646.0, "methodology": "case rate"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2711.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10913.18, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3646.47, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8655.89, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8655.89, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 2894.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VANCOMY CMPD OPTH SOL OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5332816", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMY CMPD OPTH SOL OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5332816", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 293.0, "discounted_cash": 219.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4100031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "gross_charge": 687.0, "discounted_cash": 515.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4120031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "gross_charge": 24.0, "discounted_cash": 18.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4170031", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "gross_charge": 1.0, "discounted_cash": 0.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312270", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 116.0, "discounted_cash": 87.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316600", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 125MG LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316600", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 23.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312271", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN 250MG CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312271", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 10.0, "discounted_cash": 7.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316602", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN CMPD LQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316602", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 36.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3370", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.75, "maximum": 8.75, "estimated_discounted_cash": 721.26, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325062", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.1, "discounted_cash": 0.08, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 0.31, "discounted_cash": 0.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN PER 10MG IVPB IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "5325063", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 0.31, "discounted_cash": 0.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN/2", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "4150033", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 51.36, "gross_charge": 143.0, "discounted_cash": 107.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 14.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 51.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANOMYCIN DNA AMP PROBE", "code_information": [{"code": "87500", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.1, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 57.95, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 40.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.1, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANTAS IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9225", "type": "HCPCS"}], "standard_charges": [{"minimum": 19595.75, "maximum": 19595.75, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19595.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAPOTHERM INITIAL", "code_information": [{"code": "94799", "type": "CPT"}, {"code": "5504646", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2000.0, "discounted_cash": 1500.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAPOTHERM MANAGEMENT DLY", "code_information": [{"code": "94799", "type": "CPT"}, {"code": "5504647", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 2000.0, "discounted_cash": 1500.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAR VACCINE LIVE SUBQ", "code_information": [{"code": "90716", "type": "CPT"}], "standard_charges": [{"minimum": 691.27, "maximum": 691.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 691.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARIABLE ASPHERICITY LENS", "code_information": [{"code": "V2499", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AB", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "7256266", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.85, "gross_charge": 206.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA ZOSTER AG IF", "code_information": [{"code": "87290", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.9, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.3, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.96, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 7243.68, "maximum": 7243.68, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7243.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAS CLS ANGIOSEAL", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8177901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1906.0, "discounted_cash": 1429.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VAS CLS ART CLOSER S", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8249010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2372.0, "discounted_cash": 1779.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VAS CLS ART PERCLOSE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "8240408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3002.0, "discounted_cash": 2251.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ARTERY", "code_information": [{"code": "4617242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ARTERY", "code_information": [{"code": "4917242", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC BLEED", "code_information": [{"code": "4617244", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC BLEED", "code_information": [{"code": "4917244", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC ORGAN", "code_information": [{"code": "4917243", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMB/OCC VENOUS", "code_information": [{"code": "4917241", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 60244.0, "discounted_cash": 45183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 39111.28, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1683.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 6747.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 8068.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 6747.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2341.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 6024.41, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 7481.83, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 6024.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 27635.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1986.96, "methodology": "fee 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HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 8194.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1512.99, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4296.77, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 5238.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4296.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC ENDO GROWTH FACTOR", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "7253479", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 65.51, "gross_charge": 642.0, "discounted_cash": 481.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC GRAFT INTO CARPAL BONE", "code_information": [{"code": "25430", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2702.89, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 909.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 683.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 251.26, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 269.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 615.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 683.39, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 597.59, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 178.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOACTIVE INTST POLYPEP", "code_information": [{"code": "84586", "type": "CPT"}, {"code": "7254238", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 134.01, "gross_charge": 476.0, "discounted_cash": 357.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 68.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 79.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 36.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 41.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 134.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 31.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 42.79, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.79, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN (ADH)", "code_information": [{"code": "84588", "type": "CPT"}, {"code": "7254588", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 128.73, "gross_charge": 550.0, "discounted_cash": 412.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 65.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 76.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 35.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 39.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}, {"code": "5325094", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 6.88, "maximum": 6.88, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN PER 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}, {"code": "5325094", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.88, "maximum": 6.88, "gross_charge": 9.0, "discounted_cash": 6.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4225.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1407.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 9208.68, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9208.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8220.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 3058.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3270.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1089.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VECURONIUM 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5325114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 391.0, "discounted_cash": 293.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VECURONIUM NEO IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5325117", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VECURONIUM NEO IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}, {"code": "5325117", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 39.0, "discounted_cash": 29.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEDOLIZUMAB IV PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3380", "type": "HCPCS"}, {"code": "5325119", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 83.68, "maximum": 83.68, "gross_charge": 111.0, "discounted_cash": 83.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEDOLIZUMAB IV PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3380", "type": "HCPCS"}, {"code": "5325119", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 83.68, "maximum": 83.68, "gross_charge": 111.0, "discounted_cash": 83.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 83.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}], "standard_charges": [{"minimum": 1949.83, "maximum": 1949.83, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1949.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}, {"code": "4805708", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 1612.14, "maximum": 1612.14, "gross_charge": 8285.0, "discounted_cash": 6213.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1612.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMONITORED", "code_information": [{"code": "95711", "type": "CPT"}], "standard_charges": [{"minimum": 858.62, "maximum": 858.62, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 858.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}, {"code": "4805711", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 3006.52, "maximum": 3006.52, "gross_charge": 11964.0, "discounted_cash": 8973.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3006.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}], "standard_charges": [{"minimum": 1073.91, "maximum": 1073.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1073.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}], "standard_charges": [{"minimum": 4142.3, "maximum": 4142.3, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4142.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5893.53, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1966.04, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5090.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5090.05, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1698.39, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4711.97, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1573.92, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27191.58, "maximum": 70118.41, "estimated_discounted_cash": 225668.01, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 27191.58, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 35734.89, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 34521.1, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33181.96, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 55528.5, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 70118.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN VASCULAR GRAFT", "code_information": [{"code": "C1768", "type": "HCPCS"}, {"code": "4022328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 61956.0, "discounted_cash": 46467.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1063.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 151.18, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 739.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 821.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 272.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4770.37, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 174.31, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 321.8, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 107.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4770.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 541.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 141.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 182.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 388.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 431.73, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 270.93, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1057.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 148.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 748.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 832.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 264.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 87.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 998.14, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 150.59, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 765.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 850.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 355.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 126.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1079.94, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1079.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 151.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 955.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1061.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 272.15, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 89.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 541.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 44.86, "maximum": 2861.66, "setting": "outpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2207.17, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2452.52, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2861.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VELAGLUCERASE ALFA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3385", "type": "HCPCS"}], "standard_charges": [{"minimum": 1393.57, "maximum": 1393.57, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1393.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 281.74, "estimated_discounted_cash": 511.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 281.74, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 92.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 285.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 285.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 92.62, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 465.7, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 465.7, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 148.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.81, "maximum": 41.08, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 41.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6815.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 994.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 1198.38, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1660.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 1198.38, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 751.44, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 387.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 277.38, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 676.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 751.44, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 545.55, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 178.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 377.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENA CAVA FILT", "code_information": [{"code": "C1880", "type": "HCPCS"}, {"code": "8145750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9036.0, "discounted_cash": 6777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VENDAJE, PER SQUARE CENTIMET", "code_information": [{"code": "Q4252", "type": "HCPCS"}], "standard_charges": [{"minimum": 1122.65, "maximum": 1122.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1122.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "4109009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 158.0, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 158.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "4129009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 33.49, "gross_charge": 4.0, "discounted_cash": 3.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "4159009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 33.49, "gross_charge": 27.0, "discounted_cash": 20.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "6106415", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 158.0, "gross_charge": 158.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 158.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 33.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 142.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 47.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE 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"payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312273", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 37.5MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312273", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 45.0, "discounted_cash": 33.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312278", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312278", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312274", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 52.0, "discounted_cash": 39.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENLAFAXINE 75MG XR CP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312274", "type": "CDM"}, {"code": "637", "type": "RC"}], 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[{"code": "94003", "type": "CPT"}, {"code": "5500624", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 232.66, "gross_charge": 4843.0, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 77.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23127.74, "maximum": 48872.35, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", 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[{"gross_charge": 104705.0, "discounted_cash": 78528.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS 2X8 SQ CM", "code_information": [{"code": "C9354", "type": "HCPCS"}, {"code": "4026999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5585.0, "discounted_cash": 4188.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS 4X7 SQ CM", "code_information": [{"code": "C9354", "type": "HCPCS"}, {"code": "4027000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9772.0, "discounted_cash": 7329.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS 6X8 SQ CM", "code_information": [{"code": "C9354", "type": "HCPCS"}, {"code": "4027001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16752.0, "discounted_cash": 12564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS PER SQ 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"J3396", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.74, "maximum": 43.74, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 43.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERY LNG CHN FATTY ACID", "code_information": [{"code": "82726", "type": "CPT"}, {"code": "7259920", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.91, "gross_charge": 472.0, "discounted_cash": 354.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 35.07, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICULOBULLOUS DISEASE CARR", "code_information": [{"code": "D5991", "type": "HCPCS"}], "standard_charges": [{"minimum": 280.8, "maximum": 280.8, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR DEV IMPLTJ UNI", "code_information": [{"code": "725T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY EXTEN GRAFT", "code_information": [{"code": "D7350", "type": "HCPCS"}], "standard_charges": [{"minimum": 3114.66, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3114.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY RIDGE EXTENS", "code_information": [{"code": "D7340", "type": "HCPCS"}], "standard_charges": [{"minimum": 1333.51, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1333.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIBRATE QUANT SENSORY TEST", "code_information": [{"code": "107T", "type": "CPT"}], "standard_charges": [{"minimum": 120.24, "maximum": 120.24, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 120.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VILAZODONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312332", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VILAZODONE 20MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312332", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 70.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VILAZODONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312331", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VILAZODONE 40MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312331", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 74.0, "discounted_cash": 55.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIM, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4251", "type": "HCPCS"}], "standard_charges": [{"minimum": 580.33, "maximum": 580.33, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 580.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VINBLASTINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9360", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.99, "maximum": 15.99, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VINCRISTINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9370", "type": "HCPCS"}, {"code": "5325198", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 29.3, "maximum": 29.3, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 29.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VINCRISTINE PER 1MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9370", "type": "HCPCS"}, {"code": "5325198", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 29.3, "maximum": 29.3, "gross_charge": 238.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA 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"plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 66.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL CULTURE", "code_information": [{"code": "D0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 194.96, "maximum": 194.96, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 194.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16261.05, "maximum": 34362.01, "estimated_discounted_cash": 81863.67, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 22044.35, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17512.13, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16917.31, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16261.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 27212.12, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34362.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9437.77, "maximum": 19943.41, "estimated_discounted_cash": 69105.0, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 10817.48, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10163.88, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9818.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 9437.77, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15793.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 19943.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20810.63, "maximum": 43975.94, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 24177.26, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22411.74, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21650.49, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20810.63, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34825.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43975.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8955.9, "maximum": 18925.14, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 12571.59, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 9644.94, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 9317.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 8955.9, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 14987.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 18925.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS ANTIBODY NES", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "7256782", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.85, "gross_charge": 314.0, "discounted_cash": 235.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - 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"standard_charge_dollar": 11.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257254", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.19, "gross_charge": 652.0, "discounted_cash": 489.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH/2", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257253", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.19, "gross_charge": 339.0, "discounted_cash": 254.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOC SHELL EACH/3", "code_information": [{"code": "87254", "type": "CPT"}, {"code": "7257255", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.19, "gross_charge": 342.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 74.19, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 20.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 22.76, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 74.19, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIS FIELD ASSMNT TECH SUPPT", "code_information": [{"code": "379T", "type": "CPT"}], "standard_charges": [{"minimum": 2316.08, "maximum": 2316.08, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2316.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5736.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5966.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5966.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6195.71, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VISCOSITY", "code_information": [{"code": "85810", "type": "CPT"}, {"code": "7257192", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.26, "gross_charge": 156.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.68, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1030.41, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1461.32, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 128.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1461.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT TO DETERM LDCT ELIG", "code_information": [{"code": "G0296", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 91.98, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 91.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 2.86, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 33.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 2.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 11.95, "maximum": 11.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 133.85, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 133.85, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 53.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP SCR ACUITY AUTO", "code_information": [{"code": "333T", "type": "CPT"}], "standard_charges": [{"minimum": 243.06, "maximum": 243.06, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 243.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 179.07, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 179.07, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 58.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 260.01, "maximum": 260.01, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 260.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL FIELD ASSMNT REV/RPRT", "code_information": [{"code": "378T", "type": "CPT"}], "standard_charges": [{"minimum": 108.18, "maximum": 108.18, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 108.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 420.95, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 207.22, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 60.08, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT D1 25-DIHYDROXY", "code_information": [{"code": "82652", "type": "CPT"}, {"code": "7254594", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 146.03, "gross_charge": 507.0, "discounted_cash": 380.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 74.75, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 86.92, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 40.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 44.79, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "estimated_discounted_cash": 30175.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4125.65, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1373.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4125.65, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1373.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 12774.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 10749.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4350.57, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1449.49, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY", "code_information": [{"code": "94150", "type": "CPT"}, {"code": "5501213", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 78.55, "maximum": 78.55, "gross_charge": 349.0, "discounted_cash": 261.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 78.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN A", "code_information": [{"code": "84590", "type": "CPT"}, {"code": "7254590", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 44.04, "gross_charge": 259.0, "discounted_cash": 194.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.2, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.48, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 44.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN A 10MU CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312335", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN A 10MU CP", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312335", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 100MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312363", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 100MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312363", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 250MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312365", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 250MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312365", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 500MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312360", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN B-12 500MCG TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312360", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN D 1000U TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312375", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN D 1000U TB", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5312375", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 26.64, "maximum": 112.27, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 29.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 33.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 112.27, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D/25 HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "4104595", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 112.27, "gross_charge": 491.0, "discounted_cash": 368.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 57.49, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 52.28, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 34.43, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLV AHMED GLAUCOMA", "code_information": [{"code": "C1783", "type": "HCPCS"}, {"code": "8177944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7228.0, "discounted_cash": 5421.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV CERB SPINAL", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8177942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13918.0, "discounted_cash": 10438.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV DELTA", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8177939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 44531.0, "discounted_cash": 33398.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV HAKIM BACTISEAL", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8145792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 38146.0, "discounted_cash": 28609.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV HAKIM PROGRAMABLE", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8145794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 51935.0, "discounted_cash": 38951.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV HYDROCEPH", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "8177945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45169.0, "discounted_cash": 33876.75, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV RING ANNULOPLASTY FUTURE", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20071.0, "discounted_cash": 15053.25, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV TAVR AORTIC EVPROPLUS", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309776.0, "discounted_cash": 232332.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV TAVR AORTIC TRANSCATH", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 309776.0, "discounted_cash": 232332.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV TAVR TRANSCATH SAPIEN3", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "8145308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 386904.76, "discounted_cash": 290178.57, "setting": "both", "billing_class": "facility"}]}, {"description": "VLV TRACH SPEAK", "code_information": [{"code": "L8501", "type": "HCPCS"}, {"code": "8207551", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 537.05, "maximum": 537.05, "gross_charge": 719.0, "discounted_cash": 539.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 537.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 15808.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4735.22, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 15808.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VMA URINE", "code_information": [{"code": "84585", "type": "CPT"}, {"code": "7254585", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 58.79, "gross_charge": 231.0, "discounted_cash": 173.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 30.11, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 34.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 58.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 211.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 70.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 199.4, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 66.43, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 252.08, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 84.34, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL AT/ABV", "code_information": [{"code": "93587", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 371.98, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.58, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD VNVN CLTRL BELOW", "code_information": [{"code": "93588", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 375.66, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 125.17, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 15.53, "maximum": 134.24, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 113.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLATILES", "code_information": [{"code": "84600", "type": "CPT"}, {"code": "7254600", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.9, "gross_charge": 486.0, "discounted_cash": 364.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 31.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 36.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 16.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 12.66, "maximum": 45.71, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 146.64, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VOLUME VENT SUBSQ/DLY", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "5500626", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 232.66, "gross_charge": 4843.0, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 232.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 77.88, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLUME VENTILATOR INTL", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "5500620", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 330.71, "gross_charge": 4843.0, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 330.71, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VON WILLEBRANDFC PER1UIJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7187", "type": "HCPCS"}, {"code": "5325246", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.11, "maximum": 5.11, "gross_charge": 16.0, "discounted_cash": 12.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE", "code_information": [{"code": "80285", "type": "CPT"}, {"code": "7250015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.4, "maximum": 102.83, "gross_charge": 265.0, "discounted_cash": 198.75, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 24.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 27.27, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 102.83, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 24.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312451", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 544.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312451", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 544.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG/5ML PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316668", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE 200MG/5ML PWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316668", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 338.0, "discounted_cash": 253.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE CMPD 0.1% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332828", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE CMPD 0.1% 15ML OS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332828", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 241.0, "discounted_cash": 180.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE OPHTHALM CMPD IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5332829", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 1397.0, "discounted_cash": 1047.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3465", "type": "HCPCS"}, {"code": "5325239", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 4.39, "maximum": 4.39, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE PER 10MG IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3465", "type": "HCPCS"}, {"code": "5325239", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.39, "maximum": 4.39, "gross_charge": 92.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE40MG/1MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316663", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 310.0, "discounted_cash": 232.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORICONAZOLE40MG/1MLPWLQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5316663", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 310.0, "discounted_cash": 232.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORTIOXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312461", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VORTIOXETINE 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312461", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY 1ST", "code_information": [{"code": "773T", "type": "CPT"}], "standard_charges": [{"minimum": 80.26, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC OTH PHY EA", "code_information": [{"code": "774T", "type": "CPT"}], "standard_charges": [{"minimum": 80.26, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 80.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY 1ST", "code_information": [{"code": "771T", "type": "CPT"}], "standard_charges": [{"minimum": 94.75, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR PX DISSOC SVC SM PHY EA", "code_information": [{"code": "772T", "type": "CPT"}], "standard_charges": [{"minimum": 94.75, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.75, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VR TECHNOLOGY ASSIST THERAPY", "code_information": [{"code": "770T", "type": "CPT"}], "standard_charges": [{"minimum": 6955.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8417.16, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8417.16, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 8146.15, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 8146.15, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"minimum": 12.54, "maximum": 69.79, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.54, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 69.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 16.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"minimum": 11.77, "maximum": 65.51, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VWF (VONVENDI) PER IU IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7179", "type": "HCPCS"}, {"code": "5320591", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.91, "maximum": 6.91, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VWF/FAC 8 WILATE 1U IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7183", "type": "HCPCS"}, {"code": "5325236", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.92, "maximum": 4.92, "gross_charge": 3.0, "discounted_cash": 2.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VYJUVEK 5X10^9PFU/ML, 0.1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3401", "type": "HCPCS"}], "standard_charges": [{"minimum": 3219.31, "maximum": 3219.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3219.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incontinence", "code_information": [{"code": "58293", "type": "CPT"}], "standard_charges": [{"minimum": 2996.0, "maximum": 5292.26, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5292.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 12905.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11613.0, "methodology": "per diem"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12905.0, "methodology": "per diem"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vasoreactivity study performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93896", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 166.94, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 166.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Venous-arterial shunt detection with intravenous microbubble injection performed with transcranial Doppler study of intracranial arteries, complete (List separately in addition to code for primary procedure)", "code_information": [{"code": "93898", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 232.3, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 232.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigatio", "code_information": [{"code": "G0545", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.28, "setting": "outpatient", "payers_information": [{"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 54.28, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Visual Axis Identification Using Patient Fixation During Operation", "code_information": [{"code": "514T", "type": "CPT"}], "standard_charges": [{"minimum": 827.97, "maximum": 827.97, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 827.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN", "code_information": [{"code": "80375", "type": "CPT"}, {"code": "7258258", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 0.9, "maximum": 89.59, "gross_charge": 707.0, "discounted_cash": 530.25, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 89.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312479", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 0.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312479", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312496", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 10MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312496", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312480", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 2.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312480", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312484", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 2MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312484", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312483", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 3MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312483", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312485", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 4MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312485", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312488", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312488", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 6MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312489", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 6MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312489", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312492", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN 7.5MG TB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8499", "type": "HCPCS"}, {"code": "5312492", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 17.0, "discounted_cash": 12.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WARFARIN RESPON GENETIC TEST", "code_information": [{"code": "G9143", "type": "HCPCS"}], "standard_charges": [{"minimum": 108.65, "maximum": 457.89, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 124.14, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 137.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 457.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 108.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASH HARVEST STEM CELLS", "code_information": [{"code": "38209", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1957.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2173.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 42.82, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WASHED RED BLOOD CELLS UNIT", "code_information": [{"code": "P9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 1506.28, "maximum": 1506.28, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1506.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1890.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER & NUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 701.0, "discounted_cash": 525.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WATER INJ BACST 30ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5325247", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 153.0, "discounted_cash": 114.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER INJ STERL 10ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5325250", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 162.0, "discounted_cash": 121.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER INJ STERL 20ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5325252", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 12.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER INJ STERL 50ML IJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5325254", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 205.0, "discounted_cash": 153.75, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER STERL INJ 2L IVF", "code_information": [{"code": "A4217", "type": "HCPCS"}, {"code": "5412795", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"minimum": 16.23, "maximum": 217.0, "gross_charge": 217.0, "discounted_cash": 162.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 217.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 16.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "estimated_discounted_cash": 36142.33, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2735.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 32.62, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WBC AUTO", "code_information": [{"code": "85048", "type": "CPT"}, {"code": "7255048", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 9.63, "gross_charge": 95.0, "discounted_cash": 71.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2.65, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 111.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 111.25, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 36.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE BIOPSY OF LIVER", "code_information": [{"code": "47100", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3090.8, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1034.08, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE ILIAC CREST TRICORTICAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "4027009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8543.0, "discounted_cash": 6407.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE OSTEOTOMY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4018095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19474.0, "discounted_cash": 14605.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 552.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 183.94, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 551.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 183.94, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3334.73, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1116.98, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WEDGE TIBIAL PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21932.0, "discounted_cash": 16449.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.47, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 123.52, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 278.67, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 133.2, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS", "code_information": [{"code": "86789", "type": "CPT"}, {"code": "7256784", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 54.58, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 27.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 54.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS IGM", "code_information": [{"code": "86788", "type": "CPT"}, {"code": "7256783", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 63.91, "gross_charge": 117.0, "discounted_cash": 87.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 32.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 63.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT BAND ID", "code_information": [{"code": "84182", "type": "CPT"}, {"code": "7251521", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 110.79, "gross_charge": 911.0, "discounted_cash": 683.25, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 34.96, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 40.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 110.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT TEST", "code_information": [{"code": "84181", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 64.59, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 33.08, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 38.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 64.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WET MOUNTS/ W PREPARATIONS", "code_information": [{"code": "Q0111", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.47, "maximum": 67.36, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 67.36, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR MNGMENT TRAINING", "code_information": [{"code": "97542", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 116.37, "estimated_discounted_cash": 344.0, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 116.37, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 38.78, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHFO CUSTOM FABRICATED", "code_information": [{"code": "L3808", "type": "HCPCS"}, {"code": "5803808", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 1802.96, "maximum": 1802.96, "gross_charge": 5078.0, "discounted_cash": 3808.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1802.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHFO WRST GAUNTLT MOLD", "code_information": [{"code": "L3906", "type": "HCPCS"}, {"code": "8130026", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 2151.39, "maximum": 2151.39, "gross_charge": 6060.0, "discounted_cash": 4545.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2151.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL THERAPY", "code_information": [{"code": "97022", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 62.13, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 62.13, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BLOOD FOR TRANSFUSION", "code_information": [{"code": "P9010", "type": "HCPCS"}], "standard_charges": [{"minimum": 770.36, "maximum": 770.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 770.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE BODY PHOTOGRAPHY", "code_information": [{"code": "96904", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 249.31, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 249.31, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 80.24, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81460", "type": "CPT"}], "standard_charges": [{"minimum": 1158.3, "maximum": 4881.59, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 1165.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 1295.37, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4881.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1158.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 842.4, "maximum": 3550.25, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 847.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 942.07, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3550.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 842.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.64, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 80.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WINE 120ML", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5340385", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WINE 120ML", "code_information": [{"code": "A9150", "type": "HCPCS"}, {"code": "5340385", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE CERCLAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8177975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 442.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FIXATON COM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8177985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 387.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE GUIDEPINCAL", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8137090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14869.0, "discounted_cash": 11151.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRCHNER PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13155.0, "discounted_cash": 9866.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRCHNER TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 298.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE KIRSCHNER W STOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8137102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1051.0, "discounted_cash": 788.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WIREGDE AMPLTZ", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8177990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2086.0, "discounted_cash": 1564.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP ADDL 100SQCM", "code_information": [{"code": "6906900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2395.0, "discounted_cash": 1796.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP ADDL 100SQCM", "code_information": [{"code": "6906900", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 2395.0, "discounted_cash": 1796.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G", "code_information": [{"code": "6900128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3501.0, "discounted_cash": 2625.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G", "code_information": [{"code": "6900128", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 3501.0, "discounted_cash": 2625.75, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 322.1, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 141.17, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL O", "code_information": [{"code": "6900129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 1313.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL O", "code_information": [{"code": "6900129", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 1751.0, "discounted_cash": 1313.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WNDEX FLW, BIOSKN FLW, 0.5CC", "code_information": [{"code": "Q4162", "type": "HCPCS"}], "standard_charges": [{"minimum": 7092.91, "maximum": 7092.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 7092.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 606.35, "maximum": 606.35, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 606.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 241.84, "maximum": 241.84, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 241.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND CLEANSER ANY TYPE/SIZE", "code_information": [{"code": "A6260", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND CLOSURE BY ADHESIVE", "code_information": [{"code": "G0168", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 6955.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2172.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33803.84, "maximum": 71432.53, "estimated_discounted_cash": 354012.27, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43830.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 36404.61, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 35168.08, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 33803.84, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 56569.18, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 71432.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "463", "type": "MS-DRG"}], "standard_charges": [{"minimum": 61856.67, "maximum": 130712.33, "estimated_discounted_cash": 332138.18, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 77718.33, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 66615.76, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 64353.05, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 61856.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 103514.32, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 130712.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "465", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19792.62, "maximum": 41824.74, "estimated_discounted_cash": 207659.72, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28355.64, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 21315.41, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 20591.4, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 19792.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 33122.04, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 41824.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20778.07, "maximum": 43907.14, "estimated_discounted_cash": 87098.53, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 25398.14, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22376.68, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 21616.62, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 20778.07, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 34771.15, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 43907.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45545.7, "maximum": 96244.82, "estimated_discounted_cash": 224944.25, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 58172.56, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 49049.86, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 47383.81, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 45545.7, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 76218.65, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 96244.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12693.67, "maximum": 26823.61, "setting": "inpatient", "payers_information": [{"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 16433.83, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 13670.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 13205.95, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 12693.67, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 21242.28, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 26823.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS AG 10X12", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337716", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 432.0, "discounted_cash": 324.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS AG 10X12", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337716", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 432.0, "discounted_cash": 324.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS FOAM 4X4", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337722", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 362.0, "discounted_cash": 271.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS FOAM 4X4", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337722", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 362.0, "discounted_cash": 271.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS FOAM 6X6", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337724", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 360.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DRESS FOAM 6X6", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "5337724", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 3.79, "maximum": 3.79, "gross_charge": 360.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND FILLER DRY FORM / GRAM", "code_information": [{"code": "A6262", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND FILLER GEL/PASTE /OZ", "code_information": [{"code": "A6261", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.67, "maximum": 9.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND PREP ADDL 100 CM", "code_information": [{"code": "15003", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 4425.0, "estimated_discounted_cash": 8493.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4425.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 162.04, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 83.09, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 26.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP F/N/HF/G", "code_information": [{"code": "15004", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 5579.05, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 938.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 475.66, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "6900140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 10227.0, "discounted_cash": 7670.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "6900140", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"gross_charge": 10227.0, "discounted_cash": 7670.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "15002", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 5059.0, "estimated_discounted_cash": 6895.6, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2621.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5059.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 792.17, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 413.67, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUNDEX, BIOSKIN, PER SQ CM", "code_information": [{"code": "Q4163", "type": "HCPCS"}], "standard_charges": [{"minimum": 639.64, "maximum": 639.64, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 639.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUNDFIX BIOWOUND PLUS XPLUS", "code_information": [{"code": "Q4217", "type": "HCPCS"}], "standard_charges": [{"minimum": 2962.92, "maximum": 2962.92, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2962.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUNDPLUS E-GRAT, PER SQ CM", "code_information": [{"code": "Q4277", "type": "HCPCS"}], "standard_charges": [{"minimum": 5529.25, "maximum": 5529.25, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 5529.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WR GDE SPHINCTER PRELOAD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "8035221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2644.0, "discounted_cash": 1983.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP NRV PROTCT AXOGUARD", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "4027010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 27064.0, "discounted_cash": 20298.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRIST 2 VIEWS", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "4903100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 101.06, "gross_charge": 2629.0, "discounted_cash": 1971.75, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 33.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 90.96, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 101.06, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 94.33, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 31.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST 3 VIEWS MINIMUM", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "4903110", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1.0, "maximum": 126.77, "gross_charge": 2746.0, "discounted_cash": 2059.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 58.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 43.23, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 114.09, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 126.77, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 119.75, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 39.89, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY", "code_information": [{"code": "29840", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1669.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 568.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29843", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1803.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 606.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29844", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1845.83, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 624.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29845", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2166.49, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 728.45, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29846", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1932.08, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 650.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29847", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 6323.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 2727.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6323.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2011.24, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 675.91, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ENDOSCOPY/SURGERY", "code_information": [{"code": "29848", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 20867.0, "estimated_discounted_cash": 23406.58, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 4663.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 15816.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1900.1, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 20867.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST REPLACEMENT", "code_information": [{"code": "25446", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 5390.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 8072.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4289.92, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1441.44, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 84.09, "maximum": 1516.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1516.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 292.82, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 84.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WSTNT B ENDOPROS VIABIL", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8240421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29522.0, "discounted_cash": 22141.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT B ENDOPROS VIATOR", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8240423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 50390.0, "discounted_cash": 37792.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT B ENDPR UNISTEP+DS", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8240422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9739.0, "discounted_cash": 7304.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT B ENDPROS UNISTEP+", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8240435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14583.0, "discounted_cash": 10937.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT ENTR ENDP UNSTP DS", "code_information": [{"code": "C1874", "type": "HCPCS"}, {"code": "8240420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8343.0, "discounted_cash": 6257.25, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT ENTRL ENDPR UNISTP", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8244050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13780.0, "discounted_cash": 10335.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WSTNT TBRNCH ENDP UNIST+", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "8244100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8592.0, "discounted_cash": 6444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Whole Genome Sequencing In Blood Or Bone Marrow For Acute Myelogenous Leukemia", "code_information": [{"code": "56U", "type": "CPT"}], "standard_charges": [{"minimum": 9541.67, "maximum": 9541.67, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 9541.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81470", "type": "CPT"}], "standard_charges": [{"minimum": 822.6, "maximum": 3466.8, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 827.89, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 919.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3466.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 919.94, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3466.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY ASSAY CALCULUS", "code_information": [{"code": "82370", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 47.49, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 24.34, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 28.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.13, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 47.49, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 80.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY XM PHRNX&/CRV ESOPH C+", "code_information": [{"code": "74210", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 281.06, "setting": "outpatient", "payers_information": 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 11294.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2697.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 897.9, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2473.91, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 825.02, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 11497.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 12774.0, "methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 19601.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2715.94, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/O ECP", "code_information": [{"code": "66984", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 19601.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 6480.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1969.02, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 655.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCELLERATE, PER SQ CM", "code_information": [{"code": "Q4234", "type": "HCPCS"}], "standard_charges": [{"minimum": 2385.36, "maximum": 2385.36, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2385.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCELLISTEM, 1 MG", "code_information": [{"code": "A2004", "type": "HCPCS"}], "standard_charges": [{"minimum": 1899.95, "maximum": 1899.95, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1899.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XCPSL CTRC RMVL CPLX INSJ 1+", "code_information": [{"code": "66989", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 17705.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 7432.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WORKERS COMP", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 10682.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 2996.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 11870.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3331.0, "methodology": "case rate"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 17705.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 3095.54, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1030.72, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "plan_name": "FRESENIUS HEALTH PARTNERS MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 6955.0, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA MARKETPLACE PROGRAM EXCHANGE NONPAR", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 1.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XENON 133 10 MCI", "code_information": [{"code": "A9558", "type": "HCPCS"}, {"code": "5195100", "type": "CDM"}, {"code": "343", "type": "RC"}], "standard_charges": [{"minimum": 1050.51, "maximum": 1050.51, "gross_charge": 746.0, "discounted_cash": 559.5, "setting": "both", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1050.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XK GNOTYP XK EXONS 1-3", "code_information": [{"code": "200U", "type": "CPT"}], "standard_charges": [{"minimum": 189.1, "maximum": 1042.43, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 189.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 210.12, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 1042.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XM ARCHIVE TISSUE MOLEC ANAL", "code_information": [{"code": "88363", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 84.39, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 30.84, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 37.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "MOLINA", "plan_name": "MOLINA COMPLETE CARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 28.53, "methodology": "fee schedule"}, {"payer_name": "OSCAR HEALTH PLAN", "plan_name": "OSCAR HEALTH PLAN HIX", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE MEDICAID", "standard_charge_dollar": 4.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XOME TUM & NML SPEC SEQ ALYS", "code_information": [{"code": "36U", "type": "CPT"}], "standard_charges": [{"minimum": 3288.78, "maximum": 18130.54, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 3288.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 3654.3, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 18130.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 4302.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE DIST EXT THOR AO", "code_information": [{"code": "75959", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 592.66, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 291.78, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 592.66, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE PROX EXT THOR AO", "code_information": [{"code": "75958", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 668.36, "setting": "outpatient", "payers_information": [{"payer_name": "ALIGNMENT HEALTH PLAN", "plan_name": "ALIGNMENT HEALTH PLAN MEDICARE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 339.61, "methodology": "fee schedule"}, {"payer_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "plan_name": "CARELON AKA CAREMORE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "CENTENE/HN/WELLCARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CENTENE", "plan_name": "P3 HEALTH PARTNERS - CENTENE/WELLCARE MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLEVER CARE", "plan_name": "CLEVER CARE MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CLOVER MEDICARE ADVANTAGE", "plan_name": "CLOVER MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 30.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "plan_name": "DEVOTED HEALTH MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "GOLD KIDNEY HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 668.36, "methodology": "fee schedule"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE - SCAN IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE DUAL IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "plan_name": "P3 HEALTH PARTNERS MEDICARE ADVANTAGE IPA", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 50.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "plan_name": "PROVIDER NETWORK OF AMERICA MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 65.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "RIOS HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "plan_name": "SCAN HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 20.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "VERDA HEALTH PLAN", "plan_name": "VERDA HEALTH PLAN MEDICARE ADVANTAGE", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 25.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XWRAP 1 SQ CM", "code_information": [{"code": "Q4204", "type": "HCPCS"}], "standard_charges": [{"minimum": 2901.65, "maximum": 2901.65, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 2901.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYLOSE TOLERANCE TEST", "code_information": [{"code": "84620", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 48.97, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 48.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XYNTHA INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7185", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.91, "maximum": 4.91, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Y90 IBRITUMOMAB, RX", "code_information": [{"code": "A9543", "type": "HCPCS"}], "standard_charges": [{"minimum": 267096.27, "maximum": 267096.27, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 267096.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YELLOW FEVER VACCINE SUBQ", "code_information": [{"code": "90717", "type": "CPT"}], "standard_charges": [{"minimum": 546.87, "maximum": 546.87, "setting": "outpatient", "payers_information": [{"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 546.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YERSINIA ANTIBODY", "code_information": [{"code": "86793", "type": "CPT"}], "standard_charges": [{"minimum": 1.0, "maximum": 50.03, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "standard_charge_dollar": 25.62, "methodology": "fee schedule"}, {"payer_name": "AMBETTER", "plan_name": "AMBETTER FROM ARIZONA COMPLETE HEALTH HIX", "standard_charge_dollar": 29.78, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 15.35, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 50.03, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "YOUTH SIZE BRIEF/DIAPER", "code_information": [{"code": "T4533", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YOUTH SIZE PULL-ON", "code_information": [{"code": "T4534", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA COMMERCIAL", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 100.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YT GNOTYP ACHE EXON 2", "code_information": [{"code": "201U", "type": "CPT"}], "standard_charges": [{"minimum": 127.42, "maximum": 702.46, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - HMO", "standard_charge_dollar": 127.42, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HEALTH PLAN - PPO", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA COMMERCIAL", "standard_charge_dollar": 702.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE EXCHANGE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NAVIGATE MARANA", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE NONOPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UNITED HEALTHCARE OPTIONS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": 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